Southern Cross Health Insurance — Review
6 active retail products from Southern Cross Medical Care Society · southerncross.co.nz
Last refreshed 2026-05-26 · current wordings effective 2026-04-01
Plans at a glance
KiwiCare
Wording effective 2026-04-01
Current- chemotherapy base $48,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
- specialist consultation $4,000
- psychiatric hospitalisation $2,250
RegularCare
Wording effective 2026-04-01
Current- chemotherapy base $48,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
- specialist consultation $4,000
- psychiatric hospitalisation $2,250
UltraCare
Wording effective 2026-04-01
Current- chemotherapy base $60,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
- specialist consultation $10,000
- psychiatric hospitalisation $3,500
Wellbeing Modules
Wording effective 2026-04-01
Current- physiotherapy $300
- body care podiatry $250
- day to day gp per visit $65
- vision dental audiology $200
- day to day prescriptions $600
Wellbeing One
Wording effective 2026-04-01
Current- chemotherapy base $60,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
- specialist consultation $5,000
- psychiatric hospitalisation $3,500
Coverage at a glance
One-line summary of how Southern Cross's flagship retail product (KiwiCare) handles the questions consumers most commonly ask. Full verbatim text below.
Verified policy facts — full text
Every section below is the verbatim text from each Southern Cross product's current policy wording PDF. Where a product doesn't address a topic, we show "Not on file" rather than guess.
Pharmac vs non-Pharmac drug cover
NZ's Pharmac funds a defined list of medicines. Non-Pharmac drugs (including high-cost cancer drugs like Keytruda) are excluded from public funding. Health insurance can fill that gap — but every insurer handles it differently. This page summarises each NZ insurer's non-Pharmac rules verbatim from their policy wordings.
KiwiCare
Chemotherapy for cancer (base) covers Pharmac approved chemotherapy drugs and up to $8,000 each claims year for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed. Cancer Cover Plus upgrades (Chemotherapy 100 and Chemotherapy 300) cover both Pharmac approved and non-Pharmac approved but Medsafe-indicated chemotherapy drugs with no separate sub-limit for non-Pharmac drugs, up to the respective annual limit. IV infusions (non-cancer) do not cover the cost of drugs that are not Pharmac approved. Allergy services do not cover the cost of drugs that are not Pharmac approved. RegularCare prescriptions exclude cover for drugs that are not Pharmac approved.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf · effective 2026-04-01
RegularCare
Generally, drugs must be Pharmac approved to be covered. Under the 'Chemotherapy for cancer (base)' benefit, up to $8,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer; the Cancer Cover Plus upgrades (Chemotherapy 100 and Chemotherapy 300) cover non-Pharmac-approved but Medsafe-indicated chemotherapy drugs without a stated sub-limit (subject to the overall annual cap). The 'IV infusions (non-cancer)' benefit covers IV infusions of Medsafe-indicated drugs but does not cover the cost of drugs that are not Pharmac approved. The 'Day-to-day treatment' prescriptions benefit excludes cover for drugs that are not Pharmac approved. If drugs would require special authority from Pharmac in a public facility, they are only covered if the same special authority criteria are met.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf · effective 2026-04-01
UltraCare
Under the Chemotherapy for cancer (base) benefit: Pharmac approved chemotherapy drugs are covered within the $60,000 annual limit; chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer are covered up to $10,000 each claims year (included within the $60,000 limit). Under Cancer Cover Plus upgrades (Chemotherapy 100 and Chemotherapy 300): both Pharmac approved and non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 or $300,000 each claims year respectively. Under the IV infusions (non-cancer) benefit: drugs that are not Pharmac approved are not covered. Under the Day-to-day treatment prescriptions benefit: drugs that are not Pharmac approved are excluded. Under Allergy services: drugs that are not Pharmac approved are not covered.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf · effective 2026-04-01
Wellbeing Modules
Prescriptions cover excludes cover for drugs that are not Pharmac approved
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Sales-collateral/Plan-documents/BS-Wellbeing-Modules.pdf · effective 2026-04-01
Wellbeing One
Chemotherapy for cancer (base) covers Pharmac approved chemotherapy drugs and up to $10,000 each claims year for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed. Under the Cancer Cover Plus upgrades (Chemotherapy 100 or Chemotherapy 300), chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated are covered without a separate sub-limit, subject to the overall annual cap ($100,000 or $300,000). The IV infusions (non-cancer) benefit does not cover the cost of drugs that are not Pharmac approved. The Allergy services benefit does not cover the cost of drugs that are not Pharmac approved. The Keeping Well Module and Day-to-day Module prescription benefits exclude cover for drugs that are not Pharmac approved.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Wellbeing Two
Pharmac approved chemotherapy drugs are covered under the Chemotherapy for cancer (base) benefit ($60,000 each claims year). Non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered up to $10,000 each claims year within that $60,000 limit under the base benefit. Under Cancer Cover Plus upgrades (Chemotherapy 100 or Chemotherapy 300), chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated are covered up to the upgraded annual limit ($100,000 or $300,000) with no separate sub-limit for non-Pharmac drugs. IV infusions (non-cancer) do not cover the cost of drugs that are not Pharmac approved. Allergy services do not cover the cost of drugs that are not Pharmac approved. Optional modules (Keeping Well and Day-to-day) exclude cover for drugs that are not Pharmac approved.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Compare this topic across every NZ insurer → /topics/pharmac-vs-non-pharmac/
ACC interaction
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.
KiwiCare
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 · effective 2026-04-01
RegularCare
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 · effective 2026-04-01
UltraCare
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 · effective 2026-04-01
Wellbeing Modules
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 · effective 2026-04-01
Wellbeing One
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 · effective 2026-04-01
Wellbeing Two
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 · effective 2026-04-01
Compare this topic across every NZ insurer → /topics/acc-interaction/
Mental health cover
Mental health cover varies dramatically across NZ health insurers — from entirely excluded (entry-level plans) to specific psychiatric hospitalisation sublimits. This page lists each insurer's mental-health rules with the relevant NZD sublimits and admission terms.
KiwiCare
Mental health annual sublimit: $2,250
Psychiatric hospitalisation benefit provides cover for admission and care by a specialist who is vocationally registered in psychiatry in an approved facility. We'll cover 80% of the actual charges incurred for psychiatric admission and care, to a maximum of $2,250 each claims year. Sub-limits apply: up to $450 for each night or day-stay in hospital accommodation; up to $160 each claims year for ancillary hospital charges. No excess applies to this benefit. Psychiatrist consultations are covered separately up to $600 each claims year at 80% of actual charges.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf · effective 2026-04-01
RegularCare
Mental health annual sublimit: $2,250
Cover for psychiatric hospitalisation is $2,250 each claims year. This covers admission and care by a specialist who is vocationally registered in psychiatry in an approved facility. Sub-limits apply: up to $450 for each night or day-stay in hospital accommodation, and up to $160 each claims year for ancillary hospital charges. No excess applies to this benefit. Mental health healthcare services are otherwise excluded except for psychiatrist consultations ($600 each claims year) and, for RegularCare plan holders, the Day-to-day treatment benefit.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf · effective 2026-04-01
UltraCare
Mental health annual sublimit: $1,500
Psychiatric hospitalisation is covered up to $3,500 each claims year. This requires admission and care by a specialist who is vocationally registered in psychiatry in an approved facility. Sub-limits apply: up to $700 for each night or day-stay in hospital accommodation; up to $200 each claims year for ancillary hospital charges. Reasonable charges apply. Mental health consultations (with a psychiatrist vocationally registered in psychiatry, or a psychologist registered with the New Zealand Psychologists Board) are covered up to $1,500 each claims year. General mental health costs are otherwise excluded except as covered under the Mental health consultations benefit, Psychiatric hospitalisation benefit, and Day-to-day treatment benefit.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf · effective 2026-04-01
Wellbeing Modules
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 · effective 2026-04-01
Wellbeing One
Mental health annual sublimit: $3,500
Psychiatric hospitalisation is covered up to $3,500 each claims year for admission and care by a specialist who is vocationally registered in psychiatry in an approved facility. Sub-limits apply: up to $700 for each night or day-stay in hospital accommodation, and up to $200 each claims year for ancillary hospital charges. Reasonable charges are covered. No excess applies to this benefit. Psychiatrist consultations are covered separately up to $750 each claims year (reasonable charges, no excess).
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Wellbeing Two
Mental health annual sublimit: $3,500
The 'Psychiatric hospitalisation' benefit provides cover for admission and care by a specialist who is vocationally registered in psychiatry in an approved facility. Cover is up to $3,500 each claims year, including sub-limits of up to $700 for each night or day-stay in hospital accommodation and up to $200 each claims year for ancillary hospital charges. We'll cover the reasonable charges incurred. No excess applies to this benefit. Psychiatrist consultations (outpatient) are covered under a separate benefit up to $750 each claims year.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Compare this topic across every NZ insurer → /topics/mental-health-cover/
Pre-existing conditions
NZ health insurers handle pre-existing conditions in two main ways: (1) disclose-and-accept (Southern Cross — exclude unless noted on certificate), or (2) stand-down period (nib — 3 years then covered, with permanent exclusions for certain conditions). This page lists each insurer's verbatim rules.
KiwiCare
We don't cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless we've clearly stated otherwise on your membership certificate. This exclusion doesn't apply to cover provided under the 'Day-to-day treatment' benefit if you have the RegularCare plan. Pre-existing conditions that the policyholder has made us aware of are listed on the membership certificate.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf · effective 2026-04-01
RegularCare
The policy does not cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless clearly stated otherwise on the membership certificate. This exclusion does not apply to cover provided under the 'Day-to-day treatment' benefit for RegularCare plan holders. The policyholder must disclose any health conditions, signs, symptoms on application. Pre-existing conditions may be noted on the membership certificate.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf · effective 2026-04-01
UltraCare
Pre-existing conditions are excluded unless clearly stated otherwise on the membership certificate. This exclusion does not apply after 3 years of continuous cover on this plan, and does not apply to cover under the 'Day-to-day treatment' benefit or the 'Vision and Dental' benefit (UltraCare 400 plan). Pre-existing conditions disclosed by the policyholder are listed on the membership certificate. If information on the membership certificate contradicts this policy document, the membership certificate takes precedence.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf · effective 2026-04-01
Wellbeing Modules
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 · effective 2026-04-01
Wellbeing One
Pre-existing conditions are excluded unless clearly stated otherwise on the membership certificate. This exclusion does not apply to cover provided under the optional modules. The prophylactic treatment allowance is not available if the person was confirmed as having a high risk of developing the disease the prophylactic treatment is designed to prevent before their original date of joining, unless the membership certificate specifically states otherwise.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Wellbeing Two
We don't cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless we've clearly stated otherwise on your membership certificate. This exclusion doesn't apply to cover provided under the optional modules. Pre-existing conditions that the policyholder has made us aware of are listed on the membership certificate.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Compare this topic across every NZ insurer → /topics/pre-existing-conditions/
IVF and assisted reproduction
IVF, infertility treatment, and assisted reproduction are excluded from virtually every NZ retail health insurance policy. This page documents each insurer's stance verbatim.
KiwiCare
We don't cover any costs related to infertility or assisted reproduction.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf · effective 2026-04-01
RegularCare
Infertility or assisted reproduction is explicitly excluded: 'We don't cover any costs related to infertility or assisted reproduction.'
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf · effective 2026-04-01
UltraCare
Infertility or assisted reproduction is explicitly excluded: 'We don't cover any costs related to infertility or assisted reproduction.'
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf · effective 2026-04-01
Wellbeing Modules
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 · effective 2026-04-01
Wellbeing One
We don't cover any costs related to infertility or assisted reproduction.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Wellbeing Two
We don't cover any costs related to infertility or assisted reproduction.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Compare this topic across every NZ insurer → /topics/ivf-and-assisted-reproduction/
Oncology and high-cost cancer drugs
High-cost cancer drugs (Keytruda, Opdivo, etc.) are often non-Pharmac and not covered under public health. Some NZ insurers cover these via separate cancer benefits with specific NZD caps. This page summarises each insurer's oncology / non-Pharmac chemotherapy cover.
KiwiCare
Under the base Chemotherapy for cancer benefit, up to $8,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer (within the overall $48,000 annual limit). Under Cancer Cover Plus Chemotherapy 100 and Chemotherapy 300 upgrades, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 or $300,000 each claims year respectively. In all cases, 80% of actual charges is covered.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf · effective 2026-04-01
RegularCare
Under the 'Chemotherapy for cancer (base)' benefit, up to $8,000 each claims year is included within the overall $48,000 annual limit for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer. Under the Cancer Cover Plus Chemotherapy 100 upgrade ($100,000 per claims year) and Chemotherapy 300 upgrade ($300,000 per claims year), non-Pharmac-approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, subject to the overall annual cap. No specific Keytruda example is mentioned in the policy text.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf · effective 2026-04-01
UltraCare
Under the Chemotherapy for cancer (base) benefit, chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer are covered up to $10,000 each claims year (included within the overall $60,000 annual chemotherapy limit). Under Cancer Cover Plus upgrade options, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 each claims year (Chemotherapy 100) or $300,000 each claims year (Chemotherapy 300). Cancer Cover Plus excludes the specific cancer type for which a covered person has a defined family history of cancer (two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55, where the covered person was aware or should reasonably have been aware before applying); this exclusion does not apply to the base chemotherapy benefit.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf · effective 2026-04-01
Wellbeing Modules
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 · effective 2026-04-01
Wellbeing One
Under the Chemotherapy for cancer (base) benefit, up to $10,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed, within the overall $60,000 annual limit. Under the Cancer Cover Plus upgrades (Chemotherapy 100: $100,000 per claims year; Chemotherapy 300: $300,000 per claims year), chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated are covered without a separate sub-limit up to the respective annual cap. The Cancer Cover Plus upgrade excludes cover for the specific cancer where a family history of cancer exclusion applies (two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55, where the insured was or should have been aware of the diagnosis before joining).
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Wellbeing Two
Under the Chemotherapy for cancer (base) benefit, chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed are covered up to $10,000 each claims year, within the overall $60,000 annual limit. Under Cancer Cover Plus Chemotherapy 100 upgrade, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered within the $100,000 annual limit with no separate sub-limit. Under Cancer Cover Plus Chemotherapy 300 upgrade, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered within the $300,000 annual limit with no separate sub-limit.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Compare this topic across every NZ insurer → /topics/oncology-high-cost-drugs/
Gap payment rules
When a provider's charges exceed what the insurer pays, the member pays the 'gap'. NZ insurers use different models — affiliated/preferred provider networks, percentage co-pays, 'reasonable charges' caps. This page lists each insurer's gap rules verbatim.
KiwiCare
We'll cover up to 80% of the actual charges incurred for eligible healthcare services, up to the relevant policy limits. The policyholder is responsible for paying the remaining 20% co-payment (and any excess) directly to the health services provider. When using an Affiliated Provider contracted for the healthcare service, Southern Cross will cover 80% of the charges incurred up to policy limits unless Southern Cross or the Affiliated Provider advise otherwise. If actual charges exceed policy limits, the policyholder is responsible for paying the excess amount directly to the health services provider.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf · effective 2026-04-01
RegularCare
Southern Cross covers 80% of actual charges incurred for eligible healthcare services up to policy limits, unless the insurer or Affiliated Provider specifies otherwise. The member is responsible for paying the remaining 20% co-payment (the gap) plus any excess directly to the health services provider. When using an Affiliated Provider contracted for a service, Southern Cross covers 80% of charges up to relevant policy limits unless otherwise advised. Members must also pay any amount exceeding policy limits directly to the provider. If another insurer or person is liable to contribute, the amount covered by Southern Cross is reduced by any such payment.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf · effective 2026-04-01
UltraCare
When using an Affiliated Provider contracted for a healthcare service, Southern Cross covers 100% of the actual charges incurred for eligible healthcare services up to relevant policy limits, unless Southern Cross or the Affiliated Provider advise otherwise — no gap payment applies in this case. For non-Affiliated Providers, cover is limited to reasonable charges as determined by Southern Cross; the policyholder is responsible for paying any amount exceeding reasonable charges directly to the health services provider. The policyholder is also responsible for any amount exceeding policy limits. If a healthcare service is assessed under actual charges (rather than reasonable charges), the policyholder pays any amount above the policy limit.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf · effective 2026-04-01
Wellbeing Modules
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 · effective 2026-04-01
Wellbeing One
Where Southern Cross covers 100% of actual charges (typically when an Affiliated Provider is used and unless otherwise advised), no gap applies to the insured. Where reasonable charges apply (typically for non-Affiliated Providers), the insured is responsible for paying any amount exceeding the reasonable charges directly to the health services provider. The insured is also responsible for paying any amount exceeding the policy limits and for paying any applicable excess directly to the health services provider.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Wellbeing Two
Where a healthcare service is performed by an Affiliated Provider, Southern Cross covers 100% of the actual charges incurred unless Southern Cross or the Affiliated Provider advises otherwise — in this case there is no gap for the member. Where Southern Cross covers the reasonable charges (typically when a non-Affiliated Provider is used), the member is responsible for paying any amount exceeding the reasonable charges directly to the health services provider. The member is also responsible for paying any amount exceeding the policy limits, and for paying any excess, directly to the health services provider.
Source: https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf · effective 2026-04-01
Compare this topic across every NZ insurer → /topics/gap-payment-rules/
Waiting periods, excess and exclusions
Waiting periods (days)
| Product | Surgical | Mental health | Maternity | Pre-existing |
|---|---|---|---|---|
| KiwiCare | 1095 days | — | — | — |
| RegularCare | — | — | — | — |
| UltraCare | 0 days | — | 365 days | 1095 days |
| Wellbeing Modules | — | — | — | — |
| Wellbeing One | — | — | — | — |
| Wellbeing Two | — | — | 365 days | — |
Excess options
- KiwiCare: $500
- RegularCare: $500
Exclusions
KiwiCare — 61 exclusions
- Pre-existing conditions unless clearly stated otherwise on your membership certificate
- Cystic fibrosis
- Dementia
- Kyphosis
- Loeys-Dietz syndrome
- Marfan syndrome
- Pectus carinatum
- Pectus excavatum
- Polycystic kidney disease
- Scoliosis
- Spina bifida
- Any congenital conditions except for umbilical hernia, inguinal hernia, undescended testes, hydrocele, tongue tie, phimosis, and squint
- Gynaecomastia
- Illnesses, injuries, conditions or disabilities that are caused or contributed to by the abuse of substances such as alcohol or drugs
- Self-inflicted illnesses or injuries
- Injuries or disabilities from war, or any act of war (whether declared or not)
- Injuries or disabilities from active duty in the military of any country or international authority
- Injuries or disabilities from terrorism
- Unapproved healthcare services
- ACC covered healthcare services except for the Accident and treatment injury top-up benefit
- Any surgery, procedure or treatment that changes, improves, or enhances appearance, regardless of whether it was done for medical, physical, functional, psychological, or emotional reasons
- Pregnancy and childbirth except for prescriptions and physiotherapy under the Day-to-day treatment benefit for RegularCare
- Termination of a pregnancy
- Infertility or assisted reproduction
- Contraception, including the insertion or removal of intrauterine devices, except when used for medical reasons
- Sterilisation or its reversal, for example, vasectomy
- Treatment of obesity (including weight loss surgery) except for the Gastric banding or bypass allowance
- Breast reduction except for the Breast reduction allowance
- Subsequent breast reconstruction surgery (including replacing prostheses) or breast symmetry surgery except as covered under the Surgical procedures benefit for breast reconstruction or the Breast symmetry allowance
- Gender affirmation (confirmation) surgery
- Correction of refractive visual errors or astigmatism by surgery, or by surgically implanted intraocular lenses, or by laser treatment
- Healthcare services performed by a dentist, periodontist, endodontist, or orthodontist
- Implantation of teeth, including titanium dental implants
- Extraction of teeth, which includes the complete extraction or partial removal of any part of a tooth, tooth root or tooth remnant
- Surgery that's designed to assist or allow for orthodontic healthcare services
- Health screening except for mammography, breast screening ultrasounds, and colonoscopy
- Maintenance examinations or medical check-ups
- Any examination required by a third party (including preparing reports) such as physical examinations for life insurance, travel insurance and driver licence
- Vaccinations
- Prophylactic healthcare services except for the Prophylactic treatment allowance
- Treatment for any medical condition that's not causing significant problems to your physical health
- Healthcare services that are not approved treatment
- Healthcare services provided at a public facility directly or indirectly controlled by Health NZ Te Whatu Ora except where approved in writing before treatment
- Healthcare services provided outside of New Zealand except for the Overseas treatment allowance
- Healthcare services provided by a person who is not a health services provider
- Healthcare services for skin using digital imaging technology such as mole mapping
- Pathology and laboratory tests except for the Laboratory tests benefit
- Organ transplants
- Transfusion or injection of autologous blood or blood products, except when used as part of eligible chemotherapy treatment, or where cell saver is used as part of eligible surgical treatment
- Autologous chondrocyte implants
- Stem cell transplants
- Healthcare services provided for the diagnosis, management, or treatment of developmental or congenital abnormalities of the facial skeleton and associated structures
- Healthcare services for mental health except for Psychiatrist consultation, Psychiatric hospitalisation, and Day-to-day treatment benefits
- Healthcare services provided to manage or treat snoring, or upper airways resistance, or both
- Treatment of HIV
- Appliances or equipment (surgical, medical, or dental), for example, CPAP machines, hearing aids, orthotics, crutches, surgically implanted lenses (except monofocal lenses) except as part of eligible surgical treatment on the list of prostheses and specialised equipment
- Acute care
- Administrative charges such as statement fees, cancellation fees, or nonattendance fees
- Personal costs related to a stay in hospital such as newspapers, meals for your family, alcohol, and TV rental
- Long-term care where hospitalisation lasts, or is expected to last, more than 90 days
- Respite and convalescent care
RegularCare — 65 exclusions
- Pre-existing conditions unless clearly stated otherwise on your membership certificate (this exclusion doesn't apply to cover provided under the 'Day-to-day treatment' benefit if you have the RegularCare plan)
- Cystic fibrosis
- Dementia
- Kyphosis
- Loeys-Dietz syndrome
- Marfan syndrome
- Pectus carinatum
- Pectus excavatum
- Polycystic kidney disease
- Scoliosis
- Spina bifida
- Any congenital conditions except for umbilical hernia, inguinal hernia, undescended testes, hydrocele, tongue tie, phimosis, and squint
- Gynaecomastia
- Illnesses, injuries, conditions or disabilities that are caused or contributed to by the abuse of substances such as alcohol or drugs
- Self-inflicted illnesses or injuries
- Injuries or disabilities from war, or any act of war (whether declared or not)
- Injuries or disabilities from active duty in the military of any country or international authority
- Injuries or disabilities from terrorism
- Specific drugs, devices, techniques, tests, and other healthcare services that haven't been approved by us before you receive the treatment
- Healthcare services related to, or incurred as a consequence of, any accident, treatment injury, or work-related gradual process injury, except for what you're entitled to under the 'Accident and treatment injury top-up' benefit
- Any surgery, procedure or treatment that changes, improves, or enhances appearance, regardless of whether it was done for medical, physical, functional, psychological, or emotional reasons
- Pregnancy and childbirth, except for what we cover under the 'Day-to-day treatment' benefit for prescriptions and physiotherapy if you have the RegularCare plan
- Termination of a pregnancy
- Infertility or assisted reproduction
- Contraception, including the insertion or removal of intrauterine devices, except when used for medical reasons
- Sterilisation or its reversal, for example, vasectomy
- Treatment of obesity (including weight loss surgery), except for what we cover under the 'Gastric banding or bypass allowance'
- Breast reduction, except for what we cover under the 'Breast reduction allowance'
- Subsequent breast reconstruction surgery (including replacing prostheses) or breast symmetry surgery, except for what we cover under the 'Surgical procedures' benefit for breast reconstruction and the 'Breast symmetry allowance'
- Healthcare services directly related to, or incurred as a consequence of, gender affirmation (confirmation) surgery
- Correction of refractive visual errors or astigmatism by surgery, or by surgically implanted intraocular lenses, or by laser treatment
- Healthcare services performed by a dentist, periodontist, endodontist, or orthodontist
- Implantation of teeth, including titanium dental implants
- Extraction of teeth, which includes the complete extraction or partial removal of any part of a tooth, tooth root or tooth remnant
- Surgery that's designed to assist or allow for orthodontic healthcare services
- Health screening, except for mammography and breast screening ultrasounds, and colonoscopy
- Maintenance examinations or medical check-ups
- Any examination required by a third party (including preparing reports) such as physical examinations for life insurance, travel insurance and driver licence
- Vaccinations
- Prophylactic healthcare services, except for what we cover under the 'Prophylactic treatment allowance'
- Treatment for any medical condition that's not causing significant problems to your physical health
- Healthcare services that are not approved treatment
- Healthcare services provided at a public facility that is directly or indirectly controlled by Health NZ Te Whatu Ora, except where we've approved it in writing before you receive the treatment
- Healthcare services provided outside of New Zealand, except for what we cover under the 'Overseas treatment allowance'
- Healthcare services provided by a person who is not a health services provider
- Healthcare services using technology (such as digital computer images) to help monitor and diagnose skin cancers and other skin lesions – for example, mole mapping
- Pathology and laboratory tests, except for what we cover under the 'Laboratory tests' benefit
- Organ transplants
- Transfusion or injection of autologous blood or blood products, except when used as part of eligible chemotherapy treatment, or where cell saver is used as part of eligible surgical treatment
- Autologous chondrocyte implants
- Stem cell transplants
- Healthcare services provided for the diagnosis, management, or treatment of developmental or congenital abnormalities of the facial skeleton and associated structures
- Healthcare services for mental health, except for what we cover under the 'Psychiatrist consultation' benefit, the 'Psychiatric hospitalisation' benefit, and the 'Day-to-day treatment' benefit if you have the RegularCare plan
- Healthcare services provided to manage or treat snoring, or upper airways resistance, or both
- Treatment of HIV
- Appliances or equipment (surgical, medical, or dental), for example, CPAP machines, hearing aids, orthotics, crutches, surgically implanted lenses (except monofocal lenses), except when specifically included in the list of prostheses and specialised equipment as part of eligible surgical treatment
- Acute care
- Administrative charges such as statement fees, cancellation fees, or non-attendance fees
- Hospital charges incurred for your personal convenience related to a stay in hospital, such as newspapers, meals for your family, alcohol, and TV rental
- Long-term care where hospitalisation lasts, or is expected to last, more than 90 days, including geriatric in-patient care and disability support services
- Respite and convalescent care
- Drugs that are not Pharmac approved (except as specifically permitted under chemotherapy benefits and the IV infusions non-cancer benefit for Medsafe-indicated drugs)
- Ultrasound when related to obstetrics and varicose veins (legs)
- X-ray when performed by a dentist or chiropractor
- Family history of cancer (specific cancer excluded) under Cancer Cover Plus upgrade, where two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55
UltraCare — 63 exclusions
- Pre-existing conditions (unless clearly stated otherwise on membership certificate, and does not apply after 3 years of continuous cover on this plan, or to Day-to-day treatment or Vision and Dental benefits)
- Cystic fibrosis
- Dementia
- Kyphosis
- Loeys-Dietz syndrome
- Marfan syndrome
- Pectus carinatum
- Pectus excavatum
- Polycystic kidney disease
- Scoliosis
- Spina bifida
- Any congenital conditions except for umbilical hernia, inguinal hernia, undescended testes, hydrocele, tongue tie, phimosis, and squint (exclusion does not apply after 3 years of continuous cover on this plan)
- Gynaecomastia
- Illnesses or injuries caused or contributed to by the abuse of substances such as alcohol or drugs
- Self-inflicted illnesses or injuries
- Injuries or disabilities from war, or any act of war (whether declared or not)
- Injuries or disabilities from active duty in the military of any country or international authority
- Injuries or disabilities from terrorism
- Unapproved healthcare services (specific drugs, devices, techniques, tests, and other healthcare services that haven't been approved by us before you receive the treatment)
- Healthcare services related to any accident, treatment injury, or work-related gradual process injury that ACC is legally responsible for (except for Accident and treatment injury top-up benefit)
- Cosmetic treatments and procedures (any surgery, procedure or treatment that changes, improves, or enhances appearance)
- Pregnancy and childbirth (except Obstetrics allowance and Day-to-day treatment for prescriptions or physiotherapy)
- Termination of pregnancy
- Infertility or assisted reproduction
- Contraception, including the insertion or removal of intrauterine devices (except when used for medical reasons)
- Sterilisation (except as covered under Surgical procedures benefit) and reversal of sterilisation
- Treatment of obesity including weight loss surgery (except Gastric banding or bypass allowance)
- Breast reduction (except Breast reduction allowance)
- Subsequent breast reconstruction surgery (including replacing prostheses) or breast symmetry surgery (except as covered under Surgical procedures benefit or Breast symmetry allowance)
- Gender affirmation (confirmation) surgery
- Correction of refractive visual errors or astigmatism by surgery, or by surgically implanted intraocular lenses, or by laser treatment
- Healthcare services performed by a dentist, periodontist, endodontist, or orthodontist (except Vision and dental benefit for UltraCare 400 plan)
- Dental implants including titanium dental implants (except Vision and dental benefit for UltraCare 400 plan)
- Extraction of teeth (except as covered under Surgical procedures benefit or Vision and dental benefit for UltraCare 400 plan)
- Surgery designed to assist or allow for orthodontic healthcare services (except Vision and dental benefit for UltraCare 400 plan)
- Health screening (except mammography and breast screening ultrasounds, colonoscopy, and annual health checks)
- Maintenance examinations or medical check-ups (except annual health checks)
- Any examination required by a third party such as physical examinations for life insurance, travel insurance, and driver licence
- Vaccinations (except flu vaccination under Day-to-day treatment)
- Prophylactic healthcare services (except Prophylactic treatment allowance)
- Treatment for any medical condition that's not causing significant problems to your physical health
- Healthcare services that are not approved treatment
- Healthcare services provided at a public facility that is directly or indirectly controlled by Health NZ Te Whatu Ora (except where approved in writing before treatment)
- Healthcare services provided outside of New Zealand (except Overseas treatment allowance)
- Healthcare services provided by a person who is not a health services provider
- Healthcare services using technology (such as digital computer images) to help monitor and diagnose skin cancers and other skin lesions, for example, mole mapping
- Pathology and laboratory tests (except Laboratory tests benefit)
- Organ transplants
- Transfusion or injection of autologous blood or blood products (except when used as part of eligible chemotherapy treatment, or where cell saver is used as part of eligible surgical treatment)
- Autologous chondrocyte implants
- Stem cell transplants
- Healthcare services for the diagnosis, management, or treatment of developmental or congenital abnormalities of the facial skeleton and associated structures
- Healthcare services for mental health (except Mental health consultations, Psychiatric hospitalisation, and Day-to-day treatment benefits)
- Healthcare services to manage or treat snoring or upper airways resistance
- Treatment of HIV
- Treatment of cleft palate
- Appliances or equipment (surgical, medical, or dental) such as CPAP machines, hearing aids, orthotics, crutches, surgically implanted lenses (except monofocal lenses) (except when included in list of prostheses and specialised equipment as part of eligible surgical treatment)
- Acute care
- Administrative charges such as statement fees, cancellation fees, or non-attendance fees
- Personal costs related to a stay in hospital such as newspapers, meals for your family, alcohol, and TV rental
- Long-term care where hospitalisation lasts or is expected to last more than 90 days
- Respite and convalescent care
- Family history of cancer (as defined) excluded under Cancer Cover Plus upgrade only, for the specific cancer type; does not apply to Chemotherapy for cancer (base) benefit
Wellbeing Modules — 1 exclusion
- excludes cover for drugs that are not Pharmac approved
Wellbeing One — 32 exclusions
- We don't cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless we've clearly stated otherwise on your membership certificate.
- We don't cover any costs related to, or incurred as a consequence of, the following chronic conditions: Cystic fibrosis, Dementia, Kyphosis, Loeys-Dietz syndrome, Marfan syndrome, Pectus carinatum, Pectus excavatum, Polycystic kidney disease, Scoliosis, Spina bifida.
- We don't cover any costs related to, or incurred as a consequence of, any congenital conditions except for umbilical hernia, inguinal hernia, undescended testes, hydrocele, tongue tie, phimosis, and squint.
- We don't cover any costs related to, or incurred as a consequence of, gynaecomastia.
- We don't cover any costs related to, or incurred as a consequence of: illnesses, injuries, conditions, or disabilities that are caused or contributed to by the abuse of substances such as alcohol or drugs; self-inflicted illnesses or injuries.
- We don't cover any costs related to, or incurred as a consequence of, injuries or disabilities from: war, or any act of war (whether declared or not); active duty in the military of any country or international authority; terrorism.
- We don't cover any costs related to, or incurred as a consequence of, specific drugs, devices, techniques, tests, and other healthcare services that haven't been approved by us before you receive the treatment.
- We don't cover any costs for healthcare services that are related to, or incurred as a consequence of, any accident, treatment injury, or work-related gradual process injury, except for what you're entitled to under the 'Accident and treatment injury top-up' benefit.
- We don't cover any costs related to, or incurred as a consequence of, any surgery, procedure or treatment that changes, improves, or enhances appearance, regardless of whether it was done for medical, physical, functional, psychological, or emotional reasons.
- We don't cover any costs related to, or incurred as a consequence of, pregnancy and childbirth, except for what we cover under the 'Obstetrics allowance' if you have the Wellbeing Two plan, the 'Keeping Well Module' for prescriptions, or the 'Day-to-day Module' for prescriptions or physiotherapy.
- We don't cover any costs related to, or incurred as a consequence of, termination of a pregnancy.
- We don't cover any costs related to infertility or assisted reproduction.
- We don't cover any costs related to, or incurred as a consequence of: contraception, including the insertion or removal of intrauterine devices, except when used for medical reasons; sterilisation or its reversal, for example, vasectomy.
- We don't cover any costs related to, or incurred as a consequence of, treatment of obesity (including weight loss surgery), except for what we cover under the 'Gastric banding or bypass allowance'.
- We don't cover any costs related to, or incurred as a consequence of, breast reduction, except for what we cover under the 'Breast reduction allowance'.
- We don't cover any costs related to, or incurred as a consequence of, subsequent breast reconstruction surgery (including replacing prostheses) or breast symmetry surgery, except for what we cover under the 'Surgical procedures' benefit for breast reconstruction or the 'Breast symmetry allowance'.
- We don't cover any costs for healthcare services directly related to, or incurred as a consequence of, gender affirmation (confirmation) surgery.
- We don't cover any costs related to, or incurred as a consequence of, correction of refractive visual errors or astigmatism by surgery, or by surgically implanted intraocular lenses, or by laser treatment.
- We don't cover any costs related to healthcare services performed by a dentist, periodontist, endodontist, or orthodontist, except for what we cover under the 'Keeping Well Module' or the 'Vision and Dental Module' for dental services.
- We don't cover any costs related to, or incurred as a consequence of, implantation of teeth, including titanium dental implants, except for what we cover under the 'Keeping Well Module' or the 'Vision and Dental Module' for dental services.
- We don't cover any costs related to, or incurred as a consequence of, extraction of teeth, which includes the complete extraction or partial removal of any part of a tooth, tooth root or tooth remnant, except for what we cover under the 'Surgical procedures' benefit for tooth extraction or the 'Keeping Well Module' or the 'Vision and Dental Module'.
- We don't cover any costs related to, or incurred as a consequence of, surgery that's designed to assist or allow for orthodontic healthcare services, except for what we cover under the 'Keeping Well Module' or the 'Vision and Dental Module'.
- We don't cover any costs related to: health screening (with specified exceptions); maintenance examinations or medical check-ups (except annual health checks under the 'Day-to-day Module'); any examination required by a third party.
- We don't cover any costs related to vaccinations, except for what we cover under the 'Keeping Well Module' or the 'Day-to-day Module' for flu vaccinations.
- We don't cover any costs related to, or incurred as a consequence of, prophylactic healthcare services, except for what we cover under the 'Prophylactic treatment allowance'.
- We don't cover any costs related to, or incurred as a consequence of, treatment for any medical condition that's not causing significant problems to your physical health, except for what we cover under the 'Keeping Well Module' or the 'Day-to-day Module'.
- We don't cover any costs related to, or incurred as a consequence of, healthcare services that are not approved treatment.
- We don't cover any costs for healthcare services provided at a public facility that is directly or indirectly controlled by Health NZ Te Whatu Ora, except where we've approved it in writing before you receive the treatment.
- We don't cover any costs related to, or incurred as a consequence of, healthcare services provided outside of New Zealand, except for what we cover under the 'Overseas treatment allowance'.
- We don't cover any costs related to healthcare services provided by a person who is not a health services provider.
- We don't cover any costs related to healthcare services using technology (such as digital computer images) to help monitor and diagnose skin cancers and other skin lesions – for example, mole mapping.
- We don't cover any costs for pathology and laboratory tests (subject to exceptions stated in the policy).
Wellbeing Two — 34 exclusions
- Pre-existing conditions unless clearly stated otherwise on your membership certificate
- Chronic conditions: Cystic fibrosis, Dementia, Kyphosis, Loeys-Dietz syndrome, Marfan syndrome, Pectus carinatum, Pectus excavatum, Polycystic kidney disease, Scoliosis, Spina bifida
- Any congenital conditions except for umbilical hernia, inguinal hernia, undescended testes, hydrocele, tongue tie, phimosis, and squint
- Gynaecomastia
- Illnesses, injuries, conditions, or disabilities that are caused or contributed to by the abuse of substances such as alcohol or drugs
- Self-inflicted illnesses or injuries
- Injuries or disabilities from war, or any act of war (whether declared or not)
- Injuries or disabilities from active duty in the military of any country or international authority
- Injuries or disabilities from terrorism
- Unapproved healthcare services
- Healthcare services related to any accident, treatment injury, or work-related gradual process injury (except Accident and treatment injury top-up benefit)
- Any surgery, procedure or treatment that changes, improves, or enhances appearance, regardless of whether it was done for medical, physical, functional, psychological, or emotional reasons
- Pregnancy and childbirth (except Obstetrics allowance on Wellbeing Two, and prescription/physiotherapy cover under optional modules)
- Termination of a pregnancy
- Infertility or assisted reproduction
- Contraception, including the insertion or removal of intrauterine devices, except when used for medical reasons
- Sterilisation or its reversal, for example, vasectomy
- Treatment of obesity (including weight loss surgery), except for what is covered under the Gastric banding or bypass allowance
- Breast reduction, except for what is covered under the Breast reduction allowance
- Subsequent breast reconstruction surgery (including replacing prostheses) or breast symmetry surgery, except as specified
- Gender affirmation (confirmation) surgery
- Correction of refractive visual errors or astigmatism by surgery, or by surgically implanted intraocular lenses, or by laser treatment
- Healthcare services performed by a dentist, periodontist, endodontist, or orthodontist, except under Keeping Well Module or Vision and Dental Module
- Implantation of teeth, including titanium dental implants, except under Keeping Well Module or Vision and Dental Module
- Extraction of teeth, except under Surgical procedures benefit or optional modules
- Surgery designed to assist or allow for orthodontic healthcare services, except under optional modules
- Health screening (with limited exceptions)
- Maintenance examinations or medical check-ups, except for annual health checks under Day-to-day Module
- Any examination required by a third party (including preparing reports) such as physical examinations for life insurance, travel insurance, and driver licence
- Vaccinations, except for flu vaccinations under Keeping Well Module or Day-to-day Module
- Prophylactic healthcare services, except under the Prophylactic treatment allowance
- Treatment for any medical condition that is not causing significant problems to your physical health, except under optional modules
- Healthcare services that are not approved treatment
- Healthcare services provided at a public facility
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Source documents
- KiwiCare · wording effective 2026-04-01 · https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_KiwiCare_plan.pdf
- RegularCare · wording effective 2026-04-01 · https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf
- UltraCare · wording effective 2026-04-01 · 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 · wording effective 2026-04-01 · https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Sales-collateral/Plan-documents/BS-Wellbeing-Modules.pdf
- Wellbeing One · wording effective 2026-04-01 · 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 · wording effective 2026-04-01 · https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf
The authoritative source for any specific cover question is the insurer's published PDF. Our facts are a structured derivative for comparison.
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