> _Markdown transcription of UniMed ParentStay policy wording, effective 2025-10-01. Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/ParentStay-Health-Plan-2025.pdf_ --- # ParentStay Health Plan ## UNION MEDICAL BENEFITS SOCIETY LIMITED October 2025 v1 --- # Contents - [Welcome to ParentStay](#welcome-to-parentstay) - [About us](#about-us) - [How to contact us](#how-to-contact-us) - [Terms used in this document](#terms-used-in-this-document) - [ParentStay eligibility criteria](#parentstay-eligibility-criteria) - [ParentStay at a glance](#parentstay-at-a-glance) - [Who ParentStay is for](#who-parentstay-is-for) - [We want you to understand your cover](#we-want-you-to-understand-your-cover) - [What makes up your policy](#what-makes-up-your-policy) - [What is covered (benefits)](#what-is-covered-benefits) - [What we do not cover (general exclusions)](#what-we-do-not-cover-general-exclusions) - [How to claim](#how-to-claim) - [What we will pay](#what-we-will-pay) - [Your responsibilities](#your-responsibilities) - [Changing your policy](#changing-your-policy) - [Other important information](#other-important-information) - [Glossary](#glossary) --- # Welcome to ParentStay Thank you for choosing ParentStay. ParentStay is a health insurance plan for people in New Zealand on the Parent Boost Visitor Visa. 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. 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. ## Terms used in this document Words printed in bold have their own special meanings that are defined in the glossary on pages 27. For your convenience, we have included some of the frequently used terms here. 'We', 'our' and 'us' means UniMed. 'You', 'Your' and 'Yourself' means the Primary Member and any additional Members on your policy. For explanations of medical terms, please ask your GP or other healthcare provider, or consult Healthify at healthify.nz. ## About us ### Who we are Since 1979, UniMed has been helping hardworking Kiwis and their families to access and fund the healthcare they need – when they need it. We've paid out more than $1.2 billion in claims, making a real difference in the lives of our Members. As a mutual society, we exist for our Members – not shareholders. Guided by our values of aspire, care and trust, we're here to support your health journey every step of the way. Whether you're managing an illness, staying on top of preventative care, or making informed choices about your wellbeing, UniMed is here for you. ## How to contact us - Phone: 0800 600 666 - Email: members@unimed.co.nz - Web: unimed.co.nz - Post: UniMed, PO Box 1721, Christchurch 8140 We aim to provide excellent customer service, care, and support to our Members. However, occasionally things can go wrong, or you may have concerns about a claim decision. If that is the case, then please get in contact with us. You can find further information on this under the 'Contact us if you have any concerns' section on page 25. You can download a copy of our annual report at unimed.co.nz/important-documents or contact us for a copy of our financial statements for the last reported year. --- # ParentStay eligibility criteria To be eligible for a ParentStay policy, you must meet the following criteria: - You must be in the process of obtaining the Parent Boost Visitor Visa when applying for insurance or hold a valid Parent Boost Visitor Visa. - You must meet Immigration New Zealand's Acceptable Standard of Health and all other requirements to apply for the Parent Boost Visitor Visa. - You are not eligible for this Health Plan if any of the following apply to you: - You are travelling against the advice of your specialist or GP - You have ever been diagnosed with metastatic cancer - You have been diagnosed with a terminal illness with a life expectancy of less than 24 months - You have been diagnosed with congestive heart failure - You have ever had a valve replacement - You have ever had an organ transplant - You are using home oxygen for any medical condition - You require full-time assistance in order to undertake any activities of daily living. If you apply and do not meet these criteria then you will not be eligible for cover under this Health Plan. If you provide incorrect information your policy may be cancelled from the beginning and any related claims may not be paid. --- # ParentStay at a glance This Health Plan document explains what's covered under ParentStay (benefits) and what we do not cover (general exclusions). Check your Membership Certificate for details that are specific to your policy, including any personal exclusions. ## Who ParentStay is for This ParentStay Health Plan is for people who have applied for or are in the process of applying for the Parent Boost Visitor Visa. The policy starts once you arrive in New Zealand on your Parent Boost Visitor Visa. We have designed this Health Plan to provide cover under New Zealand's public health system, while complementing the services that are provided by the Accident Compensation Corporation (ACC). ### 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 who is injured while they are in New Zealand. More information about ACC is available at acc.co.nz. - The public health system provides government-funded hospital and medical care for eligible residents and citizens in New Zealand. It delivers acute and emergency treatment through public hospitals. People on temporary visas are usually not eligible for free public healthcare and may be charged for any treatment received. - The private health system includes hospitals, specialists, and other healthcare providers that operate independently of government funding. Services are paid for by individuals. Often people will decide to have elective treatment in the private health system as it may be quicker. Please note that this policy provides limited coverage for expenses incurred in the private health system. ## Other important information We are not liable or responsible for determining or delivering the quality, standard, or effectiveness of the healthcare services, medical treatment or procedures you receive that are covered by your policy. Your healthcare providers are solely responsible for your healthcare services, medical treatment or procedures. You are responsible for obtaining your own advice about the suitability of the ParentStay Health Plan for you. --- # We want you to understand your cover ## What makes up your policy We want you to understand your policy and be confident with your health insurance, so please read all documents carefully as they are designed to be read together. You can always contact us to check your cover. Our contact details are on page 3. Your policy is made up of: 1. Your Membership Certificate that contains the details that are specific to your own policy, such as the Health Plan you are on, each additional Member who has cover, as well as any personal exclusions you or your family member may have. 2. This Health Plan document that explains what you and any additional Members are covered for (benefits), what we don't cover (general exclusions) and the terms and conditions of your policy. 3. Documents and any correspondence you have provided to us: i.e. your application including any health declaration, medical information and/or your medical history. 4. Rules of UniMed (previously referred to as Rules of the Society). You can access these documents either in your welcome pack, through the Member Portal, or via our website at unimed.co.nz/important-documents. If a document is not available through these channels, please contact us to request a copy. ## When and how we may update your policy At our discretion, we may make changes from time to time to our Health Plans, and to other documents that may affect your policy. Changes may be needed to keep your membership and insurance cover relevant, suitable for Members, in line with current trends and regulations, and financially sustainable. If we make changes to this Health Plan document or your premium, we will notify you at least 30 days before these changes take effect. Other documents may be updated from time to time, and the most recent version will be available on our website at unimed.co.nz/important-documents. If you are not happy with any change we make to your policy, please contact us to discuss your options, or you can choose to cancel your policy. ## Extra care and support Some Members are more at risk of harm because their personal circumstances make them especially vulnerable. To help us recognise and act with the appropriate level of care, please talk to one of our team about your needs so we can take extra care and provide support. We can also help you appoint a family member or friend as an 'authorised person' on your policy who can contact us on your behalf. If you have any concerns, please contact us. You can see more about how we support vulnerable Members at unimed.co.nz/members/vulnerablemembers. ## When cover under your policy starts Your policy starts from the start date (also known as the effective date) listed on your Membership Certificate and should be the date you enter New Zealand. This may be different to the date the policy is issued. If your arrival date in New Zealand changes significantly, you must let us know as soon as possible. We will review whether your policy start date needs to be updated and will advise you if we need any further information. ### 30-day free-look period We provide a 30-day free-look period that begins from the start date. 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 30-day period. If you change your mind and wish to cancel within this 30-day period, we will refund any premium paid, provided you have not made a claim under the policy. If you have made a claim that we have accepted, then we will not refund your premium. ### How your insurance works with your Parent Boost Visitor Visa You must hold a valid Parent Boost Visitor Visa at the start date of your policy and continue to hold this valid Parent Boost Visitor Visa for the duration of this policy. If at any time you no longer hold a valid Parent Boost Visitor Visa, your policy will end in accordance with the 'Ending your policy' section of this document. Because your Health Plan is directly linked to your Parent Boost Visitor Visa, UniMed may share information with Immigration New Zealand (INZ) and/or the Ministry of Business, Innovation and Employment (MBIE) to confirm the status and continuity of your insurance. This may include confirming that your policy is current and has been maintained for the duration of your stay in New Zealand. Once your policy is issued, if you develop a new health condition, experience any signs or symptoms of a condition, or have a medical event between the date you signed your application and the policy start date, you must let us know as soon as reasonably possible. This helps us confirm whether your cover is still valid or if any changes need to be made to your policy before it begins. --- # What is covered (benefits) Please take the time to read over these and ensure you understand them. Contact us if you have any queries about any of the benefits. 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 19. We also offer a growing range of benefits through our Active Benefit and Active Care offerings to help our Members stay well. For further information on these and other Member offers, please visit our website unimed.co.nz/members. ## Emergency Medical Care **Up to $250,000 for each Member each policy year.** This benefit covers the reasonable charges of emergency medical treatment you receive in a New Zealand public hospital following a medical emergency. It covers public hospital costs and related treatment or expenses listed below that occur as a direct result of the medical emergency. ### Covered costs are: #### Public hospital costs: - Emergency care - Bed and hospital accommodation - Hospital services and supplies required for your emergency care - Diagnostic tests (e.g. blood tests, scans, imaging) - In-hospital prescription drugs or medication. #### Emergency transport: - Ambulance transfer to the nearest public hospital. #### Follow-up care related to the emergency: - Specialist consultations or diagnostic tests (within 12 months of hospitalisation) when referred by the treating specialist or GP - Prescription drugs or medication prescribed by the treating specialist or GP for use outside of hospital, up to a 3-month supply and a maximum of $1,000 - Treatment by registered health practitioners (within 12 months of hospitalisation), when related to the emergency, up to a combined maximum of $1,000, including: - Occupational therapy - Physiotherapy - Speech and language therapy - Osteopathy - Chiropractic treatment - Dietitian/nutritionist consultations. #### Coordination with Medical Repatriation: - If you are diagnosed with a serious illness or disability and are claiming under this benefit, once you are medically fit to return to your country of origin, we will arrange your repatriation under the Medical Repatriation benefit. - Your cover will end upon arrival in your country of origin following repatriation. - If you are not deemed medically fit to return to your country of origin, you will continue to receive treatment under this benefit until the applicable benefit limit is reached or your policy ends, whichever occurs first. ## Cancer Care **Up to $100,000 for each Member each policy year.** This benefit covers the reasonable charges of cancer treatment you receive in a New Zealand public hospital following a diagnosis of cancer. It includes public hospital costs and related treatment or expenses that occur as a direct result of the cancer diagnosis. ### Covered costs are: #### Public hospital costs: - Treatment of cancer, whether admitted overnight, as a day patient, or as an outpatient - Chemotherapy, radiotherapy, immunotherapy, brachytherapy and oncology services - Diagnostic tests in relation to cancer treatment - In-hospital Pharmac-approved prescription drugs or medication. #### Emergency transport: - Ambulance transfer to the nearest public hospital. #### Outside of hospital costs when they occur as part of the cancer treatment: - Prescription drugs or medication that are Pharmac-approved and prescribed by the treating specialist for use at home, provided they form part of the cancer treatment. #### Coordination with Medical Repatriation: - If you are diagnosed with a serious illness or disability and are claiming under this benefit, once you are medically fit to return to your country of origin, we will arrange your repatriation under the Medical Repatriation benefit. - Your cover will end upon arrival in your country of origin following repatriation. - If you are not deemed medically fit to return to your country of origin, you will continue to receive treatment under this benefit until the applicable benefit limit is reached or your policy ends, whichever occurs first. ## Medical Repatriation **Up to $250,000 for each Member per policy lifetime.** This benefit covers the reasonable charges of us arranging and managing your return to your country of origin if you are diagnosed with a serious illness or disability and are assessed as medically fit to travel. This will also cover the cost of one nominated family member to travel with you. ### Eligibility criteria: - This benefit is only payable if medical repatriation is necessary due to a diagnosis of a serious illness or disability while in New Zealand - All repatriation arrangements must be coordinated and approved by us - We may require an assessment by a healthcare provider selected by us to confirm whether you can remain in New Zealand or are fit to return to your country of origin - Once medically repatriated, your cover under your policy will be terminated - If you remain in New Zealand despite being assessed as fit to return to your country of origin, we will not provide cover for the medical condition under your policy and may, at our discretion, cancel your policy. ### Covered costs include: - Medical repatriation expenses to return you to your country of origin - A return economy class fare on a commercial flight for one accompanying family member, as well as reasonable accommodation and meal costs up to $1,000 - A stretcher fare on a commercial flight, if medically necessary - The return airfare, accommodation, and reasonable expenses of a qualified medical attendant, if medically necessary or if required by the airline - Air ambulance transportation, if medically necessary. ### We will not pay for: - Returning to your country of origin for personal choice or for reasons outside of serious illness or disability - Any medical expenses incurred after your arrival in your country of origin - Additional expenses incurred which relate to your flight, such as shipping personal baggage - Out of pocket expenses, such as travel insurance, meals or accommodation beyond the above - Your return flight to New Zealand. ## Return of Remains **Up to $50,000 for each Member per policy lifetime.** This benefit covers the reasonable charges of returning your remains to your country of origin in the event of your death, if your family chooses to do so. ### Covered costs include: - Preparation of your body - Cremation expenses in New Zealand - Transportation of your body or ashes in a standard transportation container to your country of origin - Costs for preparing the necessary legal documentation. ### We will not pay for: - Headstones or grave markers of any kind - Burial or custom caskets or urns - Funeral service expenses, including ceremonies, receptions, or flowers. ## Mental Health **Up to $1,000 for each Member each policy year.** This benefit covers the 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 health professional association. --- # What we do not cover (general exclusions) We do not provide cover for any costs related to, or incurred as a consequence of, the health conditions, healthcare services or situations described in this section. These are general exclusions and apply to all our Members who have the ParentStay Health Plan. Any personal exclusions that relate directly to you will be listed on your Membership Certificate. We aim to fully explain what is not covered in your policy. Unless specifically provided for in a benefit on ParentStay, we do not cover any claims in relation to the general exclusions listed here. ## Health conditions we do not cover ### Pre-existing conditions We don't cover any costs related to, or incurred as a consequence of, any pre-existing conditions, unless accepted by us. ### Congenital, genetic and hereditary conditions We don't cover any costs related to, or incurred as a consequence of, a congenital condition, genetic or hereditary condition. ### Psychiatric, psychological and neurodevelopmental disorders We don't cover any costs related to, or incurred as a consequence of, any psychiatric, psychological and neurodevelopmental disorders. This includes: - Attention Deficit Hyperactivity Disorder (ADHD) - Geriatric care including geriatric hospitalisation - Pre-senile dementia - Senile illnesses including dementia and Alzheimer's disease. ### Reproductive and sexual health We don't cover any costs related to, or incurred as a consequence of, sexual or reproductive health, including: - Sexually transmitted diseases, including HIV or AIDS, or any condition caused by them - Pregnancy, childbirth, miscarriage, or termination of pregnancy - Infertility or assisted reproduction, including investigation, diagnosis, treatment, or assisted reproductive technology - Sterilisation, including reversals - Contraception of any kind, including intrauterine devices, except when used for medical reasons. ### Injury or illness from war, active duty or terrorism We don't cover any costs related to, or incurred as a consequence of, war, act of war (whether declared or not), active duty in the military of any country or international authority, or terrorism. ### Illness or injury from substance abuse or self-harm We don't cover any costs related to, or incurred as a consequence of: - Misuse of alcohol or drugs whether prescribed, non-prescription or recreational - Participation in a criminal act - Intentional self-injury - Suicide or attempted suicide - Euthanasia. ### Overseas injuries We don't cover any costs related to, or incurred as a consequence of, an injury caused by an accident outside New Zealand. ### Non-adherence to prescribed treatment We don't cover any costs related to, or incurred as a consequence of, failing to follow or comply with your prescribed medical treatment plan, including not taking prescribed medications as prescribed or not attending recommended medical appointments. ### Epidemic and pandemic We don't cover any costs related to, or incurred as a consequence of, an epidemic, pandemic or any similar widespread infectious disease. ## Healthcare services we do not cover ### Services not covered under your policy We don't cover any costs related to, or incurred as a consequence of, medical treatment or procedures, drugs or other healthcare services not covered under your policy. This includes: - Medical treatment or procedures and technologies that have not been approved by us, including any that are new, experimental, unorthodox or not widely accepted as effective, appropriate or essential according to the recognised standards of the medical specialty involved - Additional surgery performed during any operation that is not directly related to any condition or treatment covered under the terms of your policy - Any costs not specifically provided for under a benefit section outlined in this document - Medical treatment or procedures and drugs for conditions or healthcare services that are excluded under your policy, including those excluded in the eligibility criteria. ### Services provided outside of New Zealand We don't cover any costs related to, or incurred as a consequence of, healthcare services provided outside New Zealand. ### Gender affirmation and/or gender dysmorphia We don't cover any costs related to, or incurred as a consequence of, gender affirmation and/or gender dysmorphia. ### Cosmetic We don't cover any costs related to, or incurred as a consequence of, any surgery, medical treatment or procedure that primarily changes, improves, or enhances appearance, regardless of whether it is undertaken for medical, physical, functional, psychological or emotional reasons. ### Weight loss treatment We don't cover any costs related to, or incurred as a consequence of, weight loss or bariatric investigations or treatment, including when such treatment is intended to manage, treat, or improve other health conditions (for example: diabetes, cardiovascular or gastrointestinal conditions). ### Elective and revision surgery We don't cover any costs related to, or incurred as a consequence of: - Elective surgery, being any surgery that is not required to treat an acute or emergency condition - Revision surgery, performed to address failure, complications, wear and tear, unsatisfactory results, or changes to your condition. ### Orthopaedic surgery We don't cover any costs related to, or incurred as a consequence of, joint or spinal surgery, including replacement of hips, knees, or shoulders, and any procedure on the spine. ### Correction of refractive errors or astigmatism We don't cover any costs related to, or incurred as a consequence of, visual correction or enhancement treatment, including surgery, laser procedures, intraocular lens(es), injections, consultations, eye tests, glasses, or contact lenses. ### Dental care We don't cover any costs related to, or incurred as a consequence of, dental care or treatment of any kind, including routine, elective or emergency procedures, tooth extractions, exposures and the implantation of teeth, including dental implants. ### Transplants, transfusions and dialysis We don't cover any costs related to, or incurred as a consequence of, any of the following, for either the donor or recipient: - Organ transplantation - Renal dialysis - Stem cell transplantation. ### Robotically assisted surgery We don't cover any costs related to, or incurred as a consequence of, robotically assisted surgery. We may, at our sole discretion, contribute toward the cost of a robotically assisted procedure up to the reasonable charge for the equivalent non-robotic surgery. ### Preventative and maintenance services We don't cover any costs for investigations, monitoring or treatment when you are asymptomatic and there is no evidence the condition is harmful to your health. This includes: - Preventative or prophylactic care and health surveillance testing, such as mole mapping, blood tests and genetic tests - Screening or tests performed for administrative or non-clinical purposes, for example for employment, travel, visa, study or licensing reasons - Healthcare services which, in our opinion, are not medically necessary - Vaccinations/immunisations - Convalescence. ## Other expenses and costs we don't cover ### Health related appliances, equipment or devices We don't cover any costs for: - Personal health-related appliances; for example, hearing aids, personal alarms, orthotic shoes, crutches, wheelchairs, toilet seats, shower stools, mouthguards, and artificial limbs, medicine sachets or blister packs - 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. ### Long-term care We don't cover any costs related to, or incurred as a consequence of, continuous or long-term care, including aged or geriatric care, rest home or home-based care, and long-term hospital-level care, whether provided in a hospital, hospice, rest-home or similar facility. ### Recoverable expenses We don't cover any costs or expenses recoverable from a third party or insurance or any statutory scheme or any government-funded scheme or agent (for example, ACC). ### Personal costs related to hospital stay We don't cover any personal expenses incurred while in hospital. This includes charges for family meals, soft drinks, alcohol, travel costs, or accommodation for family. ### Optional or upgraded services We don't cover any costs for optional or upgraded services where they are not medically necessary, including private hospital suites, premium accommodation, travel upgrades, or any other non-medical enhancements. ### Costs not in relation to a service We don't cover any costs not specifically related to a consultation, medical treatment or procedure, such as administration costs (courier fees, charges for medical notes etc), charges for cancellation or non-attendance, or statement fees. --- # How to claim Please submit a claim as soon as you can after receiving treatment. In urgent or emergency situations, we understand this may not be possible immediately - in these cases, contact us as soon as reasonably possible so we can guide you through the claims process. Any reimbursement made to you can only be made into a New Zealand bank account you nominate. Your Health Plan covers medical emergencies; however, for occasions when you have a medical treatment or procedure scheduled in advance, we encourage you to contact us before it takes place to obtain prior approval and confirm whether it is covered under your policy. You can find further details on how to make a claim, including the documents and information you need to provide, at unimed.co.nz/claims. ## Medical events or conditions If you develop a medical condition or a medical event occurs, it may be beneficial to get in touch with us as soon as you can to allow us to provide guidance on the cover available under your policy and help you understand your options before submitting a claim. ## Conditions of cover We only accept and provide cover for costs: - covered by your policy - for a person who is covered under your policy - for a medical treatment or procedure that occurs after your policy begins and while you hold a valid Parent Boost Visitor Visa - under a policy that is current and has premium paid up to date - for benefits listed in this document - for a medical treatment or procedure provided by a healthcare provider - charged at a reasonable and fair cost (within our reasonable charges). Any past payment or acceptance of a claim does not necessarily mean that we are required to cover similar claims in the future, particularly if they fall outside of the terms of your policy. Each claim will be assessed on its own factors and in accordance with the terms in your policy at the time. The next section ('What we will pay') also lists things that may affect your claim or the amount we will pay for a particular medical treatment or procedure. --- # What we will pay ## Policy benefit limits - Unless specifically stated otherwise in this document, all benefit limits are the most we will pay for each Member in each policy year. - The benefit limits reset back to their maximum levels at the start of each policy year. - Benefit limits cannot be carried over from one policy year to the next, accumulated, or transferred to anyone else covered by the policy. - There are some benefits that have a lifetime limit, meaning once a claim has been paid up to that sum, the benefit limit reduces to zero. - We will not pay or reimburse any costs that are more than the actual costs incurred, or that are outside of reasonable charges. ## Claims with other sources You must claim any other refunds, subsidies, or entitlements available to you from another source first. This includes, but is not limited to, ACC, another health or travel insurer, a government-funded agency or scheme, or a reciprocal health agreement. If these sources fully cover your costs, you cannot claim for the same expenses under this policy. However, if they only cover part of your costs and it is legally permitted, we may pay the difference up to the amount you're entitled to under your Health Plan. We will deduct any reimbursement you receive from another source from the total amount before assessing the remaining amount against your policy benefits. We do not provide cover for any excess that applies under another insurance policy or Health Plan (whether with us or another insurer), unless specifically stated otherwise in this document. If we later identify that you have received payment or reimbursement for the same claim from another source after we have made payment, we may recover the amount we have paid to you in relation to that claim. ## Maximum cost we will pay We will pay the cost for a medical treatment or procedure that falls under your policy, up to the relevant benefit limit or the reasonable charge for the medical treatment or procedure, whichever is less. If the cost for your medical treatment or procedure exceeds the benefit limit or the reasonable charges, we will not pay the exceeded amount. The extra cost will be your responsibility and cannot be claimed under another benefit or policy you have with us. ## Conditions of cover for prescription drugs All prescription drugs and medication covered under your policy must be: - registered and approved by Medsafe for use in New Zealand; - prescribed and used within the guidelines set by Medsafe; - Pharmac-approved and listed on the Pharmac Schedule under sections A to H, for the treatment you are receiving in New Zealand; - medically necessary; and - prescribed by the treating specialist or GP. If the prescription drug requires special authority from Pharmac to be covered, we need confirmation from the healthcare provider that you meet the special authority criteria before we can assess cover for the prescription drug cost. ## ACC and injury-related claims Your Health Plan is designed to work alongside ACC. If you suffer an injury while in New Zealand, you must first apply to ACC for treatment. ACC provides comprehensive, no-fault personal injury cover for anyone in New Zealand, regardless of their residency or visa status. You must do everything you reasonably can to have ACC cover and ACC-funded treatment for your injury. If you need more information, please get in contact with us or with ACC. If ACC doesn't fully cover the cost of your medical treatment or procedure, you can make a claim with us for the rest if it is covered by your policy. Please note this is subject to the other terms of your policy, including any personal exclusions or general exclusions and benefit limits. Injuries that occurred before your policy commenced may not be covered by your policy. ### If ACC declines your claim If ACC declines your claim, then we may consider covering it under your policy. If we believe that ACC's decision to decline your claim may be wrong, we may ask you to challenge ACC's decision. The process would require your cooperation, including you giving us or our legal representative the authority to act for you in challenging ACC's decision. --- # Your responsibilities ## You must be truthful with us When you, or anyone else covered under your policy, apply for cover, request a change, make a claim, when you communicate with us, or when you are required to communicate with us, you have to always be truthful. You must take reasonable care not to misrepresent any information. This means checking that everything you give us is true, correct, complete, not misleading and you have not omitted any information. You must answer our questions carefully, honestly, and to the best of your knowledge, and provide us all information we ask for. ### If you are not truthful with us, your cover may be affected in the following ways: - If you knowingly give us information that is untrue or misleading (or if you did not care whether it was), we may: - terminate your policy with effect from the time when you provided untrue or misleading information, - refuse to pay any claims, and/or - keep any premiums you have paid. - If information turns out to be untrue or misleading because you did not take reasonable care, we may: - apply different terms to your policy, for example, by adding personal exclusions or adjusting premium or co-payment terms, and assess any claim as if those adjusted terms had been in place from the start - if we determine that we would not have provided cover on any terms without the misrepresentation, cancel your policy from the beginning and return any premiums you have paid. - If we identify that you or any additional Member did not meet the eligibility criteria for this policy, or if you provided false or misleading information about your eligibility when applying for cover, we may cancel your policy from the beginning and we may refuse to pay any related claims. If we identify fraudulent behaviour, we may take legal action against you or the additional Member involved. We may also notify Government agencies or departments such as the New Zealand Police and/or Immigration New Zealand. ## Keeping contact details up to date You need to let us know immediately if your contact details such as email address, contact number, or postal address change to make sure we have your most up to date details. We will send all communication regarding your policy to the last known email address for you. If we do not have a current email address, we will use your last known postal address. We treat our correspondence to you as delivered once we have sent it. You are responsible for passing on any information to additional Members on the policy, such as any changes or information relating to your policy. If we can't contact you using your last known email or postal address, we will stop sending communication until you have updated your contact details. If this happens, you acknowledge and agree that we have met all our obligations to send communications to you. ## Premiums ### You must pay your policy's premium You must continue to pay your premium to make sure you are a Member and are eligible for benefits. It's the responsibility of the Primary Member to make sure that the premium is up to date for you and additional Members on your policy. Premium must be paid to us annually in advance. We will notify you of any updates to your policy including your premium. ### You are only covered when you have paid your premium We may not accept a claim if your premium is not up to date, or we may deduct any premium you owe from any claim reimbursement we provide to you. We do not provide cover for any medical treatment or procedure that occurs outside the period for which the premium has been paid. We can only assess cover for a claim when the premium for your policy is up to date for the period when the medical treatment or procedure took place. ### We will cancel your policy if you haven't paid your premium for 3 months If you don't pay your premium on your policy, we will contact you to tell you that your policy has overdue premium. We may cancel your policy, if you haven't paid your premium for 3 months or longer. Cancellation takes effect from the last date you have paid premium up to. ### We may increase your premium at any time We may apply a general premium increase and other changes to premiums at any time. The premium for your Health Plan is not guaranteed. We reserve the right to review and adjust premiums at our discretion. We will give you a minimum of 30 days' notice of a change in your premium. ### We will continue to make premium deductions if your contact details change We want to make sure you are covered. If our communications are returned and marked 'no address' or your email address fails, we will continue to make deductions for your premium until you tell us otherwise. When you accept your policy, you authorise us to make premium deductions. ## Pre-existing conditions ### You must disclose pre-existing conditions Our Health Plans are designed to cover treatment for signs, symptoms or conditions that develop after the policy starts. When you apply for cover it's important that you are truthful and take reasonable care to provide accurate health information about yourself and any additional Members, including any information relating to pre-existing conditions. If you provide information that is untrue or misleading, including if you fail to provide us with information, this may affect your cover and any claims you make. Full details are in the 'You must be truthful with us' section on page 20. ### A pre-existing condition is: - any health or medical condition you are aware of, or any signs or symptoms that you are currently experiencing or have experienced in the past, that occurred before the start of your policy, or - a medical event that occurred before the start of your policy. We need to know about all previous and current signs, symptoms and conditions so we can fully assess your application. ### We may decline claims related to pre-existing conditions you have not told us about If you provide untrue or misleading information or fail to tell us about pre-existing conditions for you or any additional Member on your policy, or fail to provide information we have reasonably requested about the condition, we may decline any claim related to those conditions, and/or apply additional personal exclusions. The personal exclusion may be backdated to apply from the start of your policy. If we have already paid any claims relating to the condition, we may recover those amounts from you. Full details are in the 'You must be truthful with us' section on page 20. ### Personal exclusions are listed on your Membership Certificate Any personal exclusions or conditions limited in cover for each Member will be shown on your Membership Certificate. These personal exclusions do not apply to the Medical Repatriation or Return of Remains benefits. A personal exclusion or condition limited in cover applies to your policy where we have determined that a sign, symptom or condition is: - not covered at all; and/or - not covered for a specified length of time. You are required to read this information and let us know if anything is missing or incorrect. If a pre-existing condition is listed under the 'General exclusions' section on page 13, this condition is excluded from cover and will not be covered under your policy. It does not need to be listed on your Membership Certificate as it is a general exclusion that applies to all Members. ## Unacceptable Member behaviour We want to maintain respectful, helpful, and constructive interactions with our Members, and to provide a safe and supportive environment for our staff. We understand that issues with your policy can be frustrating, and we are committed to listening and resolving matters fairly and in a timely manner. Sometimes Members can behave in ways that are unreasonable or unacceptable, which can affect our ability to serve others and keep our workplace safe. If interactions become abusive or unreasonably demanding, we may need to take action to protect our staff and other Members. ### Types of unacceptable behaviour Unacceptable behaviour includes, but is not limited to: - Unreasonable persistence or demands: including excessive contact, repeated requests, or demands for decisions that have already been finalised. - Unwillingness to cooperate: including withholding information, making dishonest arguments, or refusing to accept reasonable explanations. - Aggression or abusive conduct: including any verbal or physical abuse, bullying, threats, or discriminatory or derogatory comments toward our staff. ### How we assess unacceptable behaviour We consider behaviour unacceptable when it: - compromises the mental or physical health, safety, or security of our staff; and/or - disrupts our ability to operate effectively for our Members. ### Possible actions If we consider that your behaviour is unacceptable: - We will contact you in writing (by email or letter) advising you that your behaviour is unacceptable. - We may limit how you can contact us (for example, requiring written communication only or using a representative). - We may issue you with a warning explaining possible consequences should your unacceptable behaviour continue. - We may terminate your policy. We reserve the right to unilaterally cancel your policy for unacceptable behaviour by you or another Member on your policy if we determine that is appropriate. We will give you up to 30 days' notice of the termination. --- # Changing your policy ## Making changes to your policy You can contact us to request changes to your policy. Making changes to your policy can affect things like your benefit limits, continuous cover, pre-existing condition cover, general and personal exclusions, and premium. We recommend that you talk to us or your financial adviser so you can fully understand the implications of any proposed changes. ## Death of the Primary Member If the Primary Member of the policy dies or is medically repatriated, the partner who has been included on the policy may retain the policy and continue paying the appropriate premium. The partner will then take over the role of the Primary Member. ## Suspending your policy You may ask us to suspend your policy (put it on hold and not pay premium) for a period of time if you are travelling overseas for 3 months or longer. You may suspend your policy for a minimum period of 3 months, up to a maximum of 12 months. You must be a Member for a minimum of 12 months before your policy can be suspended, and your policy can not be suspended for more than a total of 12 months for every 5 years of cover. We will not pay any claims for you or any additional Member for medical treatment or procedures that occur while your policy is suspended. You are unable to access Active Benefits/Care while your policy is suspended. ## Ending your policy Any medical treatment or procedures after the date of cancellation, regardless of the reason why your policy has been cancelled, will not be covered under your policy, including those you may have prior approval for. ### Cancelling your policy You can ask us to cancel your policy at any time. Cancellation must be requested by the Primary Member, financial adviser or an authorised person on your policy. Reinstatement of membership within 30 days of you cancelling your policy is at our discretion. If you apply to rejoin more than 30 days after cancelling, you may need to submit a new application and health declaration. ### How we can end your policy We can end your policy if: - you fail to pay your premium for 3 months or longer; - you or any additional Member breaches the terms of the Health Plan or the Rules of UniMed; - there is unacceptable behaviour by you or a Member on your policy; - you remain in New Zealand after you have been diagnosed with a serious illness or disability, despite being fit to return to your country of origin; - you or any additional Member no longer hold a valid Parent Boost Visitor Visa or were never eligible to hold a Parent Boost Visitor Visa; or - the last Member covered by the policy is medically repatriated or dies. We won't provide any cover, or be liable to pay any claim, if the provision of that cover, or claim payment would be to a person who is the subject of any sanction, prohibition or restriction under: - United Nations resolutions or trade or economic sanctions applied in New Zealand under the United Nations Act 1946 - the Russia Sanctions Act 2022 - the laws or regulations of the European Union, United States of America, Australia and/or New Zealand. Should we determine that the above is applicable, we may cancel the policy with immediate effect. --- # Other important information This document provides information of a factual nature only and is not an opinion or recommendation. This ParentStay policy has no surrender value. ## Membership of the Society UniMed is the trading name for Union Medical Benefits Society Limited, which is incorporated under the Industrial and Provident Societies Act 1908. ### UniMed membership Everyone insured by us is a Member of UniMed. By applying for cover, you have applied for membership of UniMed for yourself and any other person covered under your policy. When we accept your application, you and any other person covered under your policy is automatically granted membership of UniMed. This means that throughout our documents, we may refer to you as the Primary Member and all other individuals on your policy as additional Members. By becoming a Member of UniMed, you are deemed to have accepted and are bound to comply with the Rules of UniMed. The Rules of UniMed may change from time to time. A copy of the Rules of UniMed is available at unimed.co.nz/important-documents. In the event of a discrepancy between this document and the Rules of UniMed, this document takes precedence. Your membership automatically ends if your policy is cancelled or terminated, or in the event of your death. ## Contact us if you have any concerns We pride ourselves on providing great customer service, care, and support to our Members, so if you have a concern, please let us know. We will work with you to resolve your concerns as quickly as we can. We are always working on ways to improve your customer experience. You can provide your feedback to us via our website at unimed.co.nz. ### Complaints If you are unhappy with a claim or prior approval decision, or you wish to make a complaint, please follow our complaints process available at unimed.co.nz/complaints-process, or you can request a copy from us. If we have not resolved your complaint to your satisfaction or we can't reach an agreement with you about a claim or prior approval decision after the steps detailed in our complaints process, you can choose to take your concern to a free and independent dispute resolution service, the Insurance & Financial Services Ombudsman (IFSO). ## Insurance & Financial Services Ombudsman (IFSO) We are a member of an approved free and independent dispute resolution scheme operated by the Insurance and Financial Services Ombudsman (IFSO) which may help investigate and resolve a complaint if it is not resolved to your satisfaction. You can contact the IFSO if we haven't been able to reach an agreement with you. You must contact the IFSO within 3 months of us telling you, in writing, that we won't change our decision and providing you with a letter of deadlock. If we do not notify you what we have decided, then 2 months after the date of your initial complaint you can contact the IFSO. You can get more information on the IFSO at ifso.nz or by contacting them directly: - Phone: 0800 888 202 - Mail: Insurance & Financial Services Ombudsman, PO Box 10845, Wellington 6143 ## Financial Services Council We are a member of the Financial Services Council (FSC), which is a non-profit member organisation with a vision to grow the financial confidence and wellbeing of New Zealanders. FSC members commit to delivering strong consumer outcomes from a professional and sustainable financial services sector and members are required to comply with the FSC Code of Conduct. You can find more at fsc.org.nz. ## Privacy Statement — we are committed to respecting your privacy Personal and health information is collected and held by us in accordance with the Privacy Act 2020 and Health Information Privacy Code 2020 (or their successors). 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 full 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. We may update our Privacy Statement from time to time to reflect changes in our practices or legal requirements. We encourage you to review it periodically to stay informed about how we manage your information. ## New Zealand law and currency apply We conduct all our business according to the laws of New Zealand and any disputes regarding the policy are to be determined by New Zealand law. All monetary amounts in all our material are in New Zealand dollars. All benefit and premium amounts include GST. --- # Glossary This section explains the specific meaning of words and phrases that appear in bold throughout this document. Singular words in this section can also be taken to mean the plural and vice versa. The definitions in this Glossary are specific to this document. They might be different from standard medical or other common definitions. If there's ever a difference, the meanings in this Glossary are the ones that apply. ## A **ACC** is the Accident Compensation Corporation of New Zealand referred to in the Accident Compensation Act 2001 (or its successor), or any organisation providing third party injury management pursuant to the Accident Compensation Act 2001. More information about ACC can be found at acc.co.nz. **Accident** is as defined in the Accident Compensation Act 2001 (or its successor). **Activities of daily living** means the standard tasks of self-care which include: - bathing and/or showering - dressing and/or undressing - eating and/or drinking - using a toilet - moving from one location to another by either walking, using a wheelchair or with a walking aid. **Acute** means a sign, symptom, or condition that warrants care within 48 hours by a doctor or hospital admission for treatment or monitoring. ## B **Benefit** means the reimbursement available for Members for a specified medical treatment or procedure as outlined in this document. **Benefit limit** means the maximum amount that we will pay under a benefit. ## C **Claim** means the request by a Member to have their costs under their policy refunded as described in this document, providing the Member is eligible. **Condition** means any illness, injury, disease, ailment, sickness, disorder, or disability, whether diagnosed or undiagnosed, that affects your physical or mental health. **Congenital condition** means a health abnormality or defect that is present at birth (whether it is inherited or due to external factors such as drugs or alcohol or any other cause). This includes any conditions present at birth and diagnosed within the first 12 months of life, or where signs or symptoms were present before your policy began – regardless of when it was formally diagnosed. **Country of origin** means the country listed as your last country of residence in your Parent Boost Visitor Visa application or another country you have the rights to return to, such as country of citizenship. If the country's legal boundaries have changed or is no longer recognised under New Zealand law, then UniMed has the discretion to determine an alternative. ## D **Disability** means a permanent or long-term physical or mental condition that severely limits your ability to perform any activities of daily living, or prevents you from performing normal domestic duties, and requires long-term care and/or immediate specialised treatment. ## E **Event** means (without limitation) the date of birth, death, visit, consultation, test, surgery, repair, treatment or supply or the period of absence from work, duration of treatment or time in hospital. ## G **General exclusion** means a condition, treatment, or situation that we do not cover for any Member as listed in the 'General exclusions' section in this document. **GP or General practitioner** means a medical practitioner who is vocationally registered in general practice, holds a current annual practising certificate issued by the Medical Council of New Zealand and is operating within their scope. ## H **Health Plan** means the specific UniMed health insurance plan that a Member is covered under. **Healthcare provider** means a General practitioner, specialist, or registered practising member who holds a current practising certificate in compliance with the Health Practitioners Competence Assurance Act 2003 (or its successor), is a member of the appropriate registration body, and who is recognised by us. **Healthcare service** means any procedure, treatment, surgery, investigation, diagnostic test, consultation, prescription drug cost, therapeutic, rehabilitation, hospitalisation, or other healthcare service provided by a healthcare provider. **Hospice** means a healthcare facility that holds regular or associate service membership with Hospice New Zealand and provides palliative care services for patients with a terminal illness. ## L **Long-term care** means ongoing care or support required for a health condition, disability, or loss of functional ability that is not expected to improve in the short-term. It may include personal care, residential care, or other support services focused on day-to-day living rather than acute or medical treatment. ## M **Medical emergency** means a sudden, unexpected medical event or condition that requires immediate medical attention to prevent serious harm to your health. It includes situations where you: - are suffering from a serious or life-threatening condition; or - require urgent intervention to stabilise your condition and prevent serious or long-term complications. A medical emergency does not include ongoing treatment, elective procedures, or conditions known to exist before the start of your policy, unless specifically covered under a benefit in this document or agreed by us. **Medical treatment or procedure** means any procedure, treatment, surgery, investigation, diagnostic test, consultation, therapeutic, rehabilitation, hospitalisation, or other healthcare service provided by a healthcare provider. **Medically necessary** means any healthcare service that, in our opinion, is necessary for the care or treatment of a nominated health condition. **Medsafe** is the New Zealand Medicines and Medical Devices Safety Authority (or its successor), a division of the Ministry of Health, responsible for the regulation of therapeutic products in New Zealand. **Member** means a person who has been accepted as a Member of UniMed, who is named on the Membership Certificate for whom premium is currently being paid to UniMed. This could be the Primary Member or their partner on the policy. It doesn't include generic use of the word 'member' or 'members' when referring to members of families, associations, or our Member Portal. **Membership** means membership of UniMed. Everyone insured by us is a Member of UniMed. By applying for cover, you have applied for membership of UniMed for yourself and any other person covered under your policy. When we accept your application for cover, you and any other person covered under your policy is automatically granted membership of UniMed. **Membership Certificate** means the most recent Membership Certificate issued by us to a Primary Member that confirms initial acceptance of membership or subsequent alterations to the policy for all Members on the policy. **Member Portal** means the secure online platform where you can log in to view and manage your health insurance policy. Through the Member Portal, you can do things like submit and track claims, request prior approval, update your details, request to add family to your policy, and view your Health Plan document and other important documents. **Metastatic cancer** means cancer that has spread beyond the primary site to other parts of the body. ## N **Normal domestic duties** means the standard tasks associated to maintain the family home, and not for payment or reward. These tasks include: - Cleaning of the household - Cooking meals for the members of the household - Doing laundry for the members of the household - Shopping for groceries for members of the household - Taking care of any dependent relatives of the household. ## P **Partner** means the spouse or de facto partner of the Primary Member where the parties are living together in a relationship in the nature of a marriage or civil union, and who is listed on the Membership Certificate. **Personal exclusion** means signs, symptoms, medical conditions or body parts that we do not cover for a particular Member, as specified on your Membership Certificate. **Personal injury** has the meaning given in section 26 of the Accident Compensation Act 2001 (or its successor). **Pharmac** is the New Zealand Pharmaceutical Management Agency (or its successor), a Crown entity that decides which medicines and pharmaceutical products are subsidised for use in the community and public hospitals. **Pharmac Schedule** means the list of pharmaceuticals that are approved for public prescription in New Zealand and funded by Pharmac. **Policy** means your insurance contract with us that is made up of: - your Membership Certificate - this Health Plan document - documents and any correspondence you have provided to us: i.e. your application including any health declaration, medical information and/or your medical history - Rules of UniMed. **Policy year** means the 12-month period that starts on your membership commencement date or policy start date, and every 12-month period after that. **Pre-existing condition** means: - any health or medical condition you are aware of, or any signs or symptoms that you are currently experiencing or have experienced in the past, that occurred before the start of your policy or - a medical event that occurred before the start of your policy. **Premium** means the amount paid to us by you to maintain membership and eligibility for benefits. **Primary Member** means the person in whose name the policy is issued and who is responsible for the payment of premium. ## R **Reasonable charges** (previously referred to as Usual and customary charges) means charges for medical treatment or procedures that are determined by us in our sole discretion to be both: - reasonable, and - within a range of fees charged for the same or similar medical treatment or procedure. We do not pay more than what we determine to be the reasonable charge. **Rules of UniMed** (previously referred to as Rules of the Society) means the Rules of Union Medical Benefits Society Limited. ## S **Specialist** means a medical practitioner who is: - a member or fellow of an appropriately recognised specialist medical college - registered with the Medical Council of New Zealand and holds a current annual practising certificate in that specialty - holds a vocational scope of practice. This does not include those holding vocational registration for: - accident and medical practice - emergency medicine - family planning and reproductive health - general practice - medical administration - public health medicine - sexual health medicine - urgent care. The list of specialties excluded in the definition of specialist may be amended by us from time to time at our sole discretion. **Sponsoring child** means the New Zealand citizen or resident who sponsors your Parent Boost Visitor Visa application and has agreed to support you during your stay in New Zealand. If your sponsoring child is unable to communicate with UniMed regarding your policy, we may instead communicate with your next of kin or the person holding power of attorney on your behalf. **Serious illness** means a medical condition diagnosed by a New Zealand specialist or GP, that is either life-threatening, requires significant medical intervention, severely impairs your ability to undertake activities of daily living or normal domestic duties, or severely impacts your quality of life. The illness must be determined by a relevant specialist or GP as being a serious illness. **Start date** is the date your policy starts as shown on your Membership Certificate. May also be referred to as effective date on the Membership Certificate. ## T **Terminal illness** means that your life expectancy, due to sickness and regardless of any available medical treatment or procedure, is not greater than 24 months. This must be: - in the opinion of a specialist and, if we require, in the opinion of an independent specialist elected by us; and - in our assessment, having considered medical or other evidence we may require. ## U **UniMed** means Union Medical Benefits Society Limited incorporated under the Industrial and Provident Societies Act 1908 (or its successor). ## W **We, us, our** means UniMed or Union Medical Benefits Society Limited, or our authorised agents. **You, Your and Yourself** means the Primary Member and any additional Members on your policy. --- *Helping New Zealanders and their whānau stay in lifelong good health.* **UniMed** Union Medical Benefits Society Limited 165 Gloucester Street, Christchurch PO Box 1721, Christchurch 8140 unimed.co.nz **Get in touch** The team at UniMed are available to discuss your plan, and answer any questions you may have. - Phone: 0800 600 666 (freephone) - 03 365 4048 - Email: members@unimed.co.nz