Southern Cross
What does Southern Cross KiwiCare cover?
KiwiCare is a health insurance plan from Southern Cross. Its policy wording (effective 1 April 2026) sets excess option of $500, a $2,250 mental health sublimit and 61 listed exclusions.
What are the waiting periods on KiwiCare?
No general waiting period is on file for this plan. That is not the same as no wait: check the pre-existing conditions section below and the PDF.
Only general waits stated in the wording are shown. Individual benefits can have their own, longer waits (some start only after 3 years of continuous cover), and your policy certificate can list personal exclusions, so confirm in the policy wording.
Compare across insurers: NZ health insurance waiting periods.
What excess options does KiwiCare have?
The wording lists $500.
What are the benefit limits on KiwiCare?
| Benefit | Limit |
|---|---|
| Radiotherapy | Unlimited |
| Cardiac tests | $3,000 |
| Allergy services | $600 |
| Diagnostic tests | $2,000 |
| Gp minor surgery | $800 |
| Laboratory tests | $56 |
| Chemotherapy base | $48,000 |
| Diagnostic imaging | $8,000 |
| Ambulance allowance | $144 |
| Surgical procedures | $100,000 |
| Skin lesion services | $5,000 |
| Dietitian consultation | $400 |
| Regularcare orthoptist | $128 |
| Iv infusions non cancer | $600 |
| Skin lesion cryotherapy | $150 |
| Specialist consultation | $4,000 |
| Chemotherapy 100 upgrade | $100,000 |
| Chemotherapy 300 upgrade | $300,000 |
| Regularcare gp per visit | $45 |
| Psychiatrist consultation | $600 |
| Regularcare hearing tests | $128 |
| Regularcare physiotherapy | $180 |
| Regularcare prescriptions | $400 |
| Post operative home nursing | $900 |
| Psychiatric hospitalisation | $2,250 |
| Regularcare nurse per visit | $20 |
| Overseas treatment allowance | $5,000 |
| Post operative physiotherapy | $180 |
| Skin lesion gp non affiliated | $800 |
| Regularcare audiology per visit | $40 |
| Breast symmetry allowance lifetime | $10,000 |
| Travel and accommodation allowance | $400 |
| Breast reduction allowance lifetime | $15,000 |
| Post operative home nursing per day | $150 |
| Regularcare audiology consultations | $128 |
| Regularcare physiotherapy per visit | $30 |
| Psychiatric hospitalisation ancillary | $160 |
| Psychiatric hospitalisation per night | $450 |
| Post operative physiotherapy per visit | $30 |
| Post operative speech language therapy | $280 |
| Gastric banding bypass allowance lifetime | $5,000 |
| Prophylactic treatment allowance lifetime | $30,000 |
| Chemotherapy base non pharmac medsafe indicated | $8,000 |
| Post operative speech language therapy per visit | $56 |
What does KiwiCare not cover?
- 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
All Southern Cross exclusions side by side: Southern Cross exclusions.
How does KiwiCare handle Pharmac drugs, ACC, mental health and pre-existing conditions?
Pharmac vs non-Pharmac drug cover
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.
ACC interaction
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.
Mental health cover
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.
Pre-existing conditions
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.
IVF and assisted reproduction
We don't cover any costs related to infertility or assisted reproduction.
Oncology and high-cost cancer drugs
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.
Gap payment rules
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.
Get a quote for KiwiCare
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More on KiwiCare
- Wording change history
- Southern Cross review (all plans)
- Machine-readable: facts.json · wording.md
Other Southern Cross plans: RegularCare · UltraCare · Wellbeing Modules · Wellbeing One · Wellbeing Two