UniMed health insurance — what's not covered

4 exclusions from wording effective 2025-08-01 · source PDF ↗

• Major surgery
• Hospital visits
• Healthcare services performed in the specialists' rooms
• Costs for personal items such as food/food substitutes, materials or garments

9 exclusions from wording effective 2025-08-01 · source PDF ↗

• Breast reconstruction required as a result of a prophylactic mastectomy is not included.
• Costs for personal items such as food/food substitutes, materials or garments are excluded.
• Surveillance Following Cancer Treatment is not available for skin cancers/lesions removed by a minor surgery procedure performed by a specialist in their specialist room or a general practitioner in their practice room.
• Not included in cover is tooth exposure, implantation of teeth or costs of dental implants.
• All injury admissions excluded (Hospital Cash Allowance).
• Reimbursement of travel or accommodation costs is excluded (Overseas Treatment loyalty benefit).
• Spectacles/lenses replacement for loss or breakage excluded.
• Excluding removal of implants or cosmetic reduction (Obesity Surgery or Breast Reduction Surgery loyalty benefit).
• Breast reconstruction is not included under the Prophylactic Surgery loyalty benefit.

43 exclusions from wording effective 2025-10-01 · source PDF ↗

• Pre-existing conditions, unless accepted by us
• Congenital, genetic or hereditary conditions
• Psychiatric, psychological and neurodevelopmental disorders, including Attention Deficit Hyperactivity Disorder (ADHD), geriatric care including geriatric hospitalisation, pre-senile dementia, senile illnesses including dementia and Alzheimer's disease
• Sexually transmitted diseases, including HIV or AIDS, or any condition caused by them
• Pregnancy, childbirth, miscarriage, or termination of pregnancy
• Infertility or assisted reproduction, including investigation, diagnosis, treatment, or assisted reproductive technology
• Sterilisation, including reversals
• Contraception of any kind, including intrauterine devices, except when used for medical reasons
• War, act of war (whether declared or not), active duty in the military of any country or international authority, or terrorism
• Misuse of alcohol or drugs whether prescribed, non-prescription or recreational
• Participation in a criminal act
• Intentional self-injury
• Suicide or attempted suicide
• Euthanasia
• An injury caused by an accident outside New Zealand
• Failing to follow or comply with your prescribed medical treatment plan, including not taking prescribed medications as prescribed or not attending recommended medical appointments
• Epidemic, pandemic or any similar widespread infectious disease
• Medical treatment or procedures and technologies that have not been approved by us, including any that are new, experimental, unorthodox or not widely accepted as effective, appropriate or essential according to the recognised standards of the medical specialty involved
• Additional surgery performed during any operation that is not directly related to any condition or treatment covered under the terms of your policy
• Any costs not specifically provided for under a benefit section outlined in this document
• Medical treatment or procedures and drugs for conditions or healthcare services that are excluded under your policy, including those excluded in the eligibility criteria
• Healthcare services provided outside New Zealand
• Gender affirmation and/or gender dysmorphia
• Any surgery, medical treatment or procedure that primarily changes, improves, or enhances appearance, regardless of whether it is undertaken for medical, physical, functional, psychological or emotional reasons
• Weight loss or bariatric investigations or treatment, including when such treatment is intended to manage, treat, or improve other health conditions (for example: diabetes, cardiovascular or gastrointestinal conditions)
• Elective surgery, being any surgery that is not required to treat an acute or emergency condition
• Revision surgery, performed to address failure, complications, wear and tear, unsatisfactory results, or changes to your condition
• Joint or spinal surgery, including replacement of hips, knees, or shoulders, and any procedure on the spine
• Visual correction or enhancement treatment, including surgery, laser procedures, intraocular lens(es), injections, consultations, eye tests, glasses, or contact lenses
• Dental care or treatment of any kind, including routine, elective or emergency procedures, tooth extractions, exposures and the implantation of teeth, including dental implants
• Organ transplantation
• Renal dialysis
• Stem cell transplantation
• Robotically assisted surgery (though we may at our sole discretion contribute toward the cost up to the reasonable charge for the equivalent non-robotic surgery)
• Investigations, monitoring or treatment when you are asymptomatic and there is no evidence the condition is harmful to your health, including preventative or prophylactic care and health surveillance testing, screening or tests performed for administrative or non-clinical purposes, healthcare services which in our opinion are not medically necessary, vaccinations/immunisations, and convalescence
• Personal health-related appliances; for example, hearing aids, personal alarms, orthotic shoes, crutches, wheelchairs, toilet seats, shower stools, mouthguards, and artificial limbs, medicine sachets or blister packs
• Medical devices; for example, cardiac pacemakers, nerve appliances, cochlear implants, or penile implants
• Surgical or medical appliances; for example, glucometers, oxygen machines, respiratory machines, diabetic monitoring equipment, or blood pressure monitoring equipment
• Continuous or long-term care, including aged or geriatric care, rest home or home-based care, and long-term hospital-level care, whether provided in a hospital, hospice, rest-home or similar facility
• Costs or expenses recoverable from a third party or insurance or any statutory scheme or any government-funded scheme or agent (for example, ACC)
• Personal expenses incurred while in hospital, including charges for family meals, soft drinks, alcohol, travel costs, or accommodation for family
• Optional or upgraded services where they are not medically necessary, including private hospital suites, premium accommodation, travel upgrades, or any other non-medical enhancements
• Costs not specifically related to a consultation, medical treatment or procedure, such as administration costs (courier fees, charges for medical notes etc), charges for cancellation or non-attendance, or statement fees

9 exclusions from wording effective 2025-08-01 · source PDF ↗

• Breast reconstruction required as a result of a prophylactic mastectomy is not included.
• Costs for personal items such as food/food substitutes, materials or garments are excluded (Post Operative Therapy).
• Extraction or surgical removal of teeth, implantation of teeth or costs of dental implants (Oral Surgery).
• Reimbursement of travel or accommodation costs is excluded (Overseas Treatment).
• Breast reconstruction is not included under the Prophylactic Surgery benefit.
• All injury admissions are excluded (Public Hospital Cash Grant).
• Surveillance following cancer is not available for skin cancers/lesions removed by a minor surgery procedure performed by a specialist in their specialist room or a general practitioner in their practice room.
• Removing implants or cosmetic reduction are excluded from Obesity Surgery or Breast Reduction Surgery benefit.
• Children do not qualify for the Bowel Screening Kits benefit.