{ "vertical": "health", "insurer": { "slug": "unimed", "name": "UniMed", "brand_family": "unimed" }, "product": { "slug": "unicare-advantage", "name": "UniCare Advantage", "status": "active", "positioning_summary": null }, "wording": { "version": "2025-08-01", "ingested_at": "2026-05-16T11:38:38.95443+00:00", "pdf_hash": "fd2d68b0a86e9dd9e629afc87449caabb356e0269de4aa108beed955d2ddc62d", "source_url": "https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/UniCare_Advantage_Plan.pdf", "page_count": null }, "confidence_tier": "low", "facts": { "ivf_cover": "IVF is not mentioned as a covered benefit. No explicit IVF benefit is described in the policy wording.", "exclusions": [ "Breast reconstruction required as a result of a prophylactic mastectomy is not included.", "Costs for personal items such as food/food substitutes, materials or garments are excluded (Post Operative Therapy).", "Extraction or surgical removal of teeth, implantation of teeth or costs of dental implants (Oral Surgery).", "Reimbursement of travel or accommodation costs is excluded (Overseas Treatment).", "Breast reconstruction is not included under the Prophylactic Surgery benefit.", "All injury admissions are excluded (Public Hospital Cash Grant).", "Surveillance following cancer 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.", "Removing implants or cosmetic reduction are excluded from Obesity Surgery or Breast Reduction Surgery benefit.", "Children do not qualify for the Bowel Screening Kits benefit." ], "sublimits_nzd": { "ambulance": 160, "audiology": 240, "vision_care": 200, "chemotherapy": 55000, "chiropractor": 200, "gp_per_visit": 55, "physiotherapy": 300, "imaging_combined": 10000, "bereavement_grant": 600, "osteopath_per_year": 340, "radiation_oncology": 55000, "osteopath_per_visit": 170, "home_nursing_per_year": 720, "urodynamic_assessment": 900, "chiropodist_podiatrist": 240, "home_nursing_per_visit": 120, "post_operative_therapy": "1,000 per surgical event, cycle of chemotherapy and/or radiation oncology (combined maximum)", "gp_after_hours_per_year": 100, "physiotherapy_per_visit": 40, "specialist_consultation": 4000, "spinal_surgery_lifetime": 200000, "gp_after_hours_per_visit": 50, "mental_health_outpatient": 1000, "overseas_transplant_grant": 4000, "laboratory_tests_per_visit": 100, "prescriptions_user_charges": 240, "cardiac_diagnostic_combined": 1200, "minor_skin_lesions_per_year": 1100, "non_pharmac_drugs_inpatient": 330, "obstetrics_loyalty_per_year": 300, "psychiatric_hospitalisation": 3500, "parent_accommodation_per_year": 500, "minor_surgery_gp_per_admission": 400, "non_pharmac_chemotherapy_drugs": 8500, "parent_accommodation_per_night": 100, "dietitian_nutritionist_per_year": 160, "dietitian_nutritionist_per_visit": 40, "gastroscopy_colonoscopy_per_year": 5000, "minor_skin_lesions_per_admission": 550, "overseas_treatment_loyalty_grant": 5000, "surgical_admission_per_admission": 100000, "minor_surgery_specialist_per_year": 1210, "non_acute_medical_hospitalisation": 3500, "non_pharmac_drugs_general_medical": 330, "acute_private_hospitalisation_grant": 2500, "public_hospital_cash_grant_per_year": 1680, "prophylactic_surgery_loyalty_lifetime": 25000, "surveillance_colonoscopy_per_24_months": 2500, "surveillance_following_cancer_per_year": 3000, "public_hospital_cash_grant_per_24_hours": 150, "breast_symmetry_post_mastectomy_lifetime": 6500, "oral_surgery_rooms_surgeon_per_admission": 720, "psychiatric_consultations_loyalty_per_year": "Three Visits", "oral_surgery_hospital_surgeon_per_admission": 720, "oral_surgery_hospital_theatre_per_admission": 2000, "psychiatric_consultations_loyalty_per_visit": 150, "oral_surgery_rooms_anaesthetist_per_admission": 360, "oral_surgery_hospital_anaesthetist_per_admission": 360, "oral_surgery_hospital_accommodation_per_admission": 6400, "obesity_or_breast_reduction_surgery_loyalty_lifetime": 4000 }, "gap_payment_rules": "Payments under the Private Hospitalisation Surgical Benefits section are limited to 80% of the Reasonable charges of the procedure up to the per admission limit stated. All benefit sections from the Public Hospital Benefits section forward refund 80% of actual medical costs to the specified maximums. The General Medical Expenses section also refunds 80% of actual medical costs to the specified maximums. All benefits are inclusive of GST charged by healthcare providers.", "acc_interaction_rules": "For Accident Surgery, UniMed must receive written confirmation from ACC regarding their decision to accept or decline the claim before qualifying surgical procedures are undertaken. If ACC accepts the claim, UniMed provides 'top-up' coverage to the benefit levels applicable to the Private Hospitalisation Surgical Benefits section. If ACC declines the 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 ACC would have contributed had the claim been accepted. For non-hospital ACC top-up, 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 shown under the General Medical Expenses and Minor Surgery benefit sections; ACC must have provided financial assistance towards treatment costs for a claim to qualify.", "mental_health_sublimit_nzd": 1000, "mental_health_admission_rules": "Psychiatric Hospitalisation in a Licensed Private Hospital on admission and under the care of a Specialist Psychiatrist. Refund of Hospital Accommodation Fees and ancillary hospital charges up to $3,500 per policy year. Under the Loyalty Benefits (after five years' continuous membership), consultations with a vocationally registered psychiatrist in New Zealand are covered at $150 per visit up to three visits per policy year.", "oncology_high_cost_drugs_cover": "Non-Pharmac chemotherapy drugs that are Medsafe approved for the treatment of cancer are covered up to $8,500 per annum, included within the overall Chemotherapy benefit of $55,000 per policy year. Genetic/genomic testing is also included, payable following a cancer diagnosis and referral by a Registered Oncologist.", "pharmac_vs_non_pharmac_drug_rules": "Pharmac-approved chemotherapy drugs are covered under the Chemotherapy benefit (up to $55,000 per policy year). Non-Pharmac chemotherapy drugs that are Medsafe approved for the treatment of cancer are covered up to $8,500 per annum within the Chemotherapy benefit. Non-Pharmac subsidised pharmaceuticals (prescribed by a Registered Medical Practitioner, approved by Medsafe, and not fully or partly subsidised by Pharmac through the New Zealand Pharmaceutical Schedule) are covered up to $330 per policy year under both the In-Patient Non-Pharmac Subsidised Pharmaceuticals benefit and the General Medical Expenses Non-Pharmac Subsidised Pharmaceuticals benefit. User part charges for prescription items on the New Zealand Pharmaceutical Schedule are covered up to $240 per policy year." }, "endpoints": { "summary": "/api/product/unimed/unicare-advantage/summary.md", "wording": "/api/product/unimed/unicare-advantage/wording.md", "history": "/api/product/unimed/unicare-advantage/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/unimed/unicare-advantage/facts.json", "generated_at": "2026-05-16T12:53:21.757Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }