# ACC Interaction in NZ Health Insurance

In NZ, ACC covers accidental injury and treatment-injury costs. Health insurance generally excludes ACC-covered events but most policies offer an ACC Top-Up benefit for any shortfall. This page summarises each insurer's ACC interaction rules verbatim.

_All facts below are extracted verbatim from each insurer's published policy wording PDF (see Source links). For the authoritative answer in any specific case, refer to the source PDF._

## Per-product breakdown

### Accuro

**KidSmart** `accuro/kidsmart` — wording effective 2026-05-16 — confidence `inferred`

KidSmart is designed to complement ACC and will not cover claims related to accidents that ACC covers. If ACC does not cover the full amount, the policy may pay the difference (up to Reasonable charges and the benefit limit) if the treatment is covered under the policy. The guardian/child must first pursue the ACC full payment option. Under the ACC partial payment option, the policy covers the cost difference up to Reasonable charges or the benefit limit, whichever is less. If ACC declines cover, the insurer may ask for a review or appeal and requires the ACC decline letter within 3 months of issue. If ACC reverses its decision, the insurer may seek reimbursement for claims already paid. If ACC refuses or stops cover because of non-compliance with ACC requirements, no claim can be made under the policy. Any expense recoverable from ACC is excluded. ACC top-up benefit covers any shortfall between ACC's payment and actual private hospital costs; the applicable benefit's maximum limit applies.

> Source: [https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/KidSmart-Sept-2025.pdf](https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/KidSmart-Sept-2025.pdf)
**SmartCare** `accuro/smartcare` — wording effective 2026-05-16 — confidence `inferred`

The SmartCare Health Plan is designed to complement ACC and will not cover claims related to accidents that ACC covers. If ACC doesn't cover the full amount for treatment, the policy may pay the difference if there is cover for that treatment under the policy. Under the ACC full payment option, all claims must be submitted to ACC. Under the ACC partial payment option, the policy covers the difference in cost up to Reasonable charges or the benefit limit, whichever is less. If ACC declines cover, UniMed may ask for a review or appeal with the member's support; if ACC reverses its decision, UniMed may seek reimbursement. If ACC refuses or stops cover because the member is not complying with ACC's requirements, no claim can be made under the policy. Any expense recoverable from ACC is excluded. Any medical costs declined by ACC if injury is caused by an accident outside New Zealand are not covered.

> Source: [https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/SmartCare-Sept-2025.pdf](https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/SmartCare-Sept-2025.pdf)
**SmartCare+** `accuro/smartcare-plus` — wording effective 2026-05-16 — confidence `inferred`

SmartCare+ is designed to complement ACC and will not cover claims related to accidents that ACC covers. If ACC does not cover the full amount for treatment, the policy may pay the difference if the treatment is covered under the policy. The full payment option (where ACC contracts a provider and pays the total cost) should be the member's first choice. Under the ACC partial payment option, SmartCare+ covers the difference in cost up to Reasonable charges or the benefit limit, whichever is less. If ACC declines cover, UniMed may ask for a review or appeal, requiring the member to provide the ACC decline letter within 3 months. If ACC refuses or stops cover due to non-compliance by the member, the member cannot claim under the policy. Any ACC reimbursement is deducted from the total before assessing the amount under the policy benefit. The ACC top-up benefit covers any shortfall between what ACC pays and the actual costs of the surgical procedure or medical treatment in an approved private hospital or facility, subject to the excess and benefit maximums.

> Source: [https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/SmartCare%2B-Sept-2025.pdf](https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/SmartCare%2B-Sept-2025.pdf)
**SmartStay** `accuro/smartstay` — wording effective 2026-05-16 — confidence `inferred`

SmartStay is designed to complement ACC and will not cover claims related to accidents that ACC covers. The full payment option (ACC contracts a provider and pays total cost) should be the first choice; in that case all claims must be submitted to ACC. Under the ACC partial payment option, SmartStay will cover the difference in cost up to the Reasonable charges or the benefit limit, whichever is less, provided the treatment is covered under the policy. If ACC declines cover, UniMed may ask for a review or appeal with member support, requiring the ACC decline letter and relevant information within 3 months of its issue date. If ACC refuses or stops cover due to member non-compliance with ACC requirements, no claim can be made under the policy. Any expense recoverable from ACC is excluded. Medical costs declined by ACC for injuries caused by accidents outside New Zealand are not covered. UniMed will not cover any excess applicable under another insurance plan.

> Source: [https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/SmartStay-Sept-2025.pdf](https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/SmartStay-Sept-2025.pdf)
**StaffCare** `accuro/staffcare` — wording effective 2026-05-16 — confidence `verified`

The StaffCare Health Plan is designed to complement ACC and will not cover claims related to accidents that ACC covers. If ACC does not cover the full amount for treatment, the policy may pay the difference if there is cover for that treatment under the policy. Under the ACC full payment option, ACC pays the total cost and all claims must be submitted to ACC. Under the ACC partial payment option, the policy covers the shortfall up to Reasonable charges or the benefit limit, whichever is less. If ACC declines cover, the insurer may ask for a review or appeal, requiring the member to provide the ACC decline letter within 3 months. The insurer will not cover any medical costs declined by ACC if injury is caused by an accident outside New Zealand. Any expense recoverable from ACC is excluded. The ACC top-up benefit covers the shortfall between what ACC pays and actual costs of surgical procedure or medical treatment in an approved private hospital or facility, subject to the excess and benefit maximum.

> Source: [https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/StaffCare-Sept-2025.pdf](https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/StaffCare-Sept-2025.pdf)
**StaffCare+** `accuro/staffcare-plus` — wording effective 2026-05-16 — confidence `inferred`

StaffCare+ is designed to complement ACC and will not cover claims related to accidents that ACC covers. The full payment option (ACC contracts a provider and pays the total cost) should be the first choice, in which case all claims must be submitted to ACC. Under the ACC partial payment option, StaffCare+ will cover the difference in cost up to the Reasonable charges or the benefit limit, whichever is less, provided the treatment is covered under the policy. If ACC declines cover for treatment covered under the policy, UniMed may ask for a review or appeal and needs the ACC decline letter and relevant information within 3 months of its issue date. If ACC refuses or stops cover because the Member is not complying with ACC's requirements, no claim can be made under the policy. An ACC top-up loyalty benefit is also available under the base plan: UniMed covers any shortfall between what ACC pays and the actual costs of the surgical procedure or medical treatment in an approved private hospital or facility, subject to the applicable excess and benefit maximum. We won't pay any costs that amount to more than 100% of actual costs incurred, and any ACC reimbursement is deducted before assessing the amount against the policy benefit.

> Source: [https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/StaffCare%2B-Sept-2025.pdf](https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/StaffCare%2B-Sept-2025.pdf)
### AIA

**AIA Private Health** `aia/private-health` — wording effective 2026-05-16 — confidence `verified`

This policy does not cover any costs arising from treatments or procedures for accidents or injuries including treatment injuries (medical misadventure) that ACC is legally responsible to pay. The life assured must submit any accident-related claim to ACC first, and must obtain prior approval from ACC before incurring private treatment costs. When ACC agrees to contribute, AIA may cover additional costs up to the reasonable charges or maximum cover of this policy (prior approval from AIA required). If ACC declines, AIA reserves the right to require the life assured to apply to ACC for a review before AIA considers the claim. If ACC upholds a decline, AIA may cover costs up to the reasonable charges or maximum cover (prior approval required). AIA will not pay for any MRI or CT scans or other specialised imaging procedures recommended by a registered medical practitioner within seven days of an accidental injury claim being lodged with ACC. If ACC does not cover the claim due to the policy owner's or life assured's failure to properly make a claim with ACC or comply with ACC's claims requirements, AIA will deem the life assured has not made reasonable efforts to secure cover with ACC and so is not able to claim under this policy.

> Source: [https://www.aia.co.nz/content/dam/nz/en/docs/our-products/policy-wordings/health/aia-private-health-umbrella-policy-wording.pdf](https://www.aia.co.nz/content/dam/nz/en/docs/our-products/policy-wordings/health/aia-private-health-umbrella-policy-wording.pdf)
### nib

**Easy Health** `nib/easy-health` — wording effective 2024-09-20 — confidence `inferred`

Injuries covered by ACC are a general exclusion and are not covered under this policy. The ACC Top-Up Benefit covers the difference if ACC claim payments do not fully cover the cost of surgery or medical treatment for a physical injury, up to the benefit limit remaining on the Surgical or Non-Surgical Benefit; injuries that occurred before the join date are not covered under this benefit. The Cover in Australia Benefit excludes surgery or treatment relating to an injury which would be covered under ACC if it had happened in New Zealand. If nib believes ACC should pay for a health service rather than nib, nib may ask ACC to review their decision on the policyholder's behalf, requiring full cooperation including granting legal authority, providing case summaries and ACC decline letters, and other relevant information. The Public Hospital Payment benefit does not cover any admission related to an acute condition.

> Source: [https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf](https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf)
**Ultimate Health** `nib/ultimate-health` — wording effective 2025-11-24 — confidence `inferred`

Injuries that are covered by ACC are excluded from cover. The ACC Top-Up Benefit pays the difference if ACC claim payments don't fully cover the cost of surgery or medical treatment for a physical injury, up to the benefit limit remaining on the Surgical or Non-Surgical Benefit. Injuries that occurred before the join date are not covered under the ACC Top-Up Benefit. The ACC Treatment Injury Benefit covers surgery or treatment needed to treat or repair an injury sustained during a health service paid for by nib, to the extent not covered by ACC, up to the remaining Surgical or Non-Surgical Benefit limit. If nib has paid for treatment and ACC reimburses the insured person, the reimbursement must be forwarded to nib.

> Source: [https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf](https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf)
**Ultimate Health Max** `nib/ultimate-health-max` — wording effective 2024-02-01 — confidence `verified`

The ACC Top-Up Benefit covers the difference between what ACC pays and the cost of surgery or medical treatment for a physical injury, up to the remaining Surgical or Non-Surgical Benefit limit. Injuries that occurred before the join date are excluded. If ACC reimburses the insured person after nib has paid, the reimbursement must be forwarded to nib. Under the Cover in Australia Benefit, surgery or treatment relating to an injury that would be covered under ACC if it had happened in New Zealand is excluded. The ACC Treatment Injury Benefit covers surgery or treatment needed to treat or repair an injury sustained during a health service paid for by nib that is not covered by ACC, up to the remaining Surgical or Non-Surgical Benefit limit; if ACC declines to pay, nib may request an ACC review on the insured person's behalf.

> Source: [https://assets.ctfassets.net/ja9v5o5o08yv/7Acf9tvW7QiaF1lSLqnV0p/8282b54901949d83eeda17b5398ea67c/Ultimate_Health_Max_Policy_Document__effective_for_new_policies_or_policies_renewing_from_1_February_2024_or_later_.pdf](https://assets.ctfassets.net/ja9v5o5o08yv/7Acf9tvW7QiaF1lSLqnV0p/8282b54901949d83eeda17b5398ea67c/Ultimate_Health_Max_Policy_Document__effective_for_new_policies_or_policies_renewing_from_1_February_2024_or_later_.pdf)
### Southern Cross

**KiwiCare** `southern-cross/kiwicare` — wording effective 2026-04-01 — confidence `verified`

The KiwiCare and RegularCare plans do not provide cover for healthcare services related to acute care or to an accident, treatment injury or work-related gradual process injury that ACC is legally responsible for. If ACC does not pay the full amount charged, you may claim the shortfall under the relevant benefit via the 'Accident and treatment injury top-up' benefit — up to 80% of the remaining cost after the ACC contribution has been deducted, subject to the policy limits for the relevant benefit. You must do everything reasonably possible to obtain ACC approval for payment, including signing all documents to enable Southern Cross to protect any ACC entitlement.

> Source: [https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf](https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf)
**RegularCare** `southern-cross/regularcare` — wording effective 2026-04-01 — confidence `verified`

The plans do not provide cover for healthcare services related to acute care or to an accident, treatment injury, or work-related gradual process injury that ACC is legally responsible for. However, if ACC does not pay the full amount charged, the member may claim the shortfall under the 'Accident and treatment injury top-up' benefit — the policy covers up to 80% of the remaining eligible cost after the ACC contribution has been deducted, up to the policy limits for the relevant benefit. Members must do everything reasonably possible to obtain ACC approval before claiming the top-up, including signing all documents to enable Southern Cross to protect any entitlement from ACC.

> Source: [https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf](https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf)
**UltraCare** `southern-cross/ultracare` — wording effective 2026-04-01 — confidence `inferred`

The UltraCare plans do not cover healthcare services related to acute care or to an accident, treatment injury, or work-related gradual process injury that ACC is legally responsible for. However, if ACC does not pay the full amount charged for treatment, the policyholder can claim the shortfall under the relevant benefit via the 'Accident and treatment injury top-up' benefit, subject to that benefit's policy limits and terms. The insured must do everything reasonably possible to obtain ACC approval for payment, including signing all necessary documents, and must co-operate to enable Southern Cross to protect any ACC entitlement.

> Source: [https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf](https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf)
**Wellbeing Modules** `southern-cross/wellbeing-modules` — wording effective 2026-04-01 — confidence `low`

_Not on file for this product._

> Source: [https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Sales-collateral/Plan-documents/BS-Wellbeing-Modules.pdf](https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Sales-collateral/Plan-documents/BS-Wellbeing-Modules.pdf)
**Wellbeing One** `southern-cross/wellbeing-one` — wording effective 2026-04-01 — confidence `inferred`

The Wellbeing plans do not provide cover for healthcare services related to an accident, treatment injury, or work-related gradual process injury that ACC is legally responsible for. Where ACC does not pay the full amount charged, the insured may claim the shortfall under the 'Accident and treatment injury top-up' benefit, subject to the policy limits and conditions of the relevant benefit. The insured must do everything reasonably possible to obtain ACC approval for payment, including signing all necessary documents to enable Southern Cross to protect any ACC entitlement.

> Source: [https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf](https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf)
**Wellbeing Two** `southern-cross/wellbeing-two` — wording effective 2026-04-01 — confidence `inferred`

The Wellbeing plans do not provide cover for healthcare services related to acute care or to an accident, treatment injury or work-related gradual process injury that ACC is legally responsible for. If ACC does not pay the full amount charged for treatment, the member can make a claim for the shortfall under the relevant benefit if that healthcare service is covered under the policy — this is the 'Accident and treatment injury top-up' benefit. The member must do everything reasonably possible to obtain ACC approval for payment, including signing all documents and doing everything necessary to enable Southern Cross to protect any entitlement from ACC. Southern Cross will cover the remaining cost of the eligible healthcare service after the ACC contribution has been deducted, up to the policy limits for the relevant benefit.

> Source: [https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf](https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf)
### UniMed

**Health Positive** `unimed/health-positive` — wording effective 2025-08-01 — confidence `inferred`

_Not on file for this product._

> Source: [https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/Health_Positive_Plan.pdf](https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/Health_Positive_Plan.pdf)
**Hospital Select** `unimed/hospital-select` — wording effective 2025-08-01 — confidence `low`

For Accident Surgery: Before Qualifying Surgical Procedures are undertaken UniMed must receive written confirmation from ACC regarding their decision to either accept or decline the claim for surgery. Qualifying Injury Claims that 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 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 by them to the levels applicable to the Private Hospitalisation Surgical Benefits section. For ACC Top Up Benefit (across base plan and modules): 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. For a claim to qualify, ACC must have provided financial assistance towards treatment costs. Emergency ambulance benefit excludes injuries.

> Source: [https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/Hospital_Select_Plus_Modules_Plan.pdf](https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/Hospital_Select_Plus_Modules_Plan.pdf)
**ParentStay** `unimed/parentstay` — wording effective 2025-10-01 — confidence `inferred`

The Health Plan is designed to work alongside ACC. If a member suffers an injury while in New Zealand, they must first apply to ACC for treatment. ACC provides comprehensive, no-fault personal injury cover for anyone in New Zealand regardless of residency or visa status. Members must do everything reasonably possible to have ACC cover and ACC-funded treatment for their injury. If ACC does not fully cover the cost of medical treatment or procedure, a claim can be made with UniMed for the remainder if it is covered by the policy, subject to other policy terms including exclusions and benefit limits. Costs or expenses recoverable from ACC are excluded. If ACC declines a claim, UniMed may consider covering it under the policy. If UniMed believes ACC's decision to decline may be wrong, it may ask the member to challenge ACC's decision and requires the member's cooperation including authority to act on their behalf.

> Source: [https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/ParentStay-Health-Plan-2025.pdf](https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/ParentStay-Health-Plan-2025.pdf)
**UniCare Advantage** `unimed/unicare-advantage` — wording effective 2025-08-01 — confidence `low`

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.

> Source: [https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/UniCare_Advantage_Plan.pdf](https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/UniCare_Advantage_Plan.pdf)

## Other comparison topics

- [Pharmac vs Non-Pharmac Drug Cover in NZ Health Insurance](/api/topic/pharmac-vs-non-pharmac/summary.md) — `pharmac-vs-non-pharmac`
- [Mental Health Cover in NZ Health Insurance](/api/topic/mental-health-cover/summary.md) — `mental-health-cover`
- [Pre-Existing Conditions and NZ Health Insurance](/api/topic/pre-existing-conditions/summary.md) — `pre-existing-conditions`
- [IVF and Assisted Reproduction Cover in NZ Health Insurance](/api/topic/ivf-and-assisted-reproduction/summary.md) — `ivf-and-assisted-reproduction`
- [Oncology and High-Cost Cancer Drugs in NZ Health Insurance](/api/topic/oncology-high-cost-drugs/summary.md) — `oncology-high-cost-drugs`
- [Gap Payment Rules in NZ Health Insurance](/api/topic/gap-payment-rules/summary.md) — `gap-payment-rules`

## Coverage notes

- Insurers in this comparison: Accuro, AIA, nib, Southern Cross, UniMed
- Products compared: 20 active retail products
- Each product links to its source PDF + structured machine-readable facts at `/api/product/{insurer}/{product}/facts.json`
- This page is generated from `insurance.wording_facts` JSONB rows in our Supabase data layer

## Citation

Cite as: "ACC Interaction in NZ Health Insurance", healthinsurancecomparison.co.nz, accessed 2026-05-16.
Canonical URL: https://healthinsurancecomparison.co.nz/api/topic/acc-interaction/summary.md
License: CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz
Primary sources: each insurer's policy wording PDF linked inline above.

Generated 2026-05-16T12:54:55.811Z.