UniMed
What does UniMed UniCare Advantage cover?
UniCare Advantage is a health insurance plan from UniMed. Its policy wording (effective 1 August 2025) sets a $1,000 mental health sublimit and 9 listed exclusions.
What are the waiting periods on UniCare Advantage?
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 UniCare Advantage have?
No excess amounts were extracted from this wording; excess is usually chosen on application.
What are the benefit limits on UniCare Advantage?
| Benefit | Limit |
|---|---|
| Ambulance | $160 |
| Audiology | $240 |
| Vision care | $200 |
| Chemotherapy | $55,000 |
| Chiropractor | $200 |
| Gp per visit | $55 |
| Physiotherapy | $300 |
| Imaging combined | $10,000 |
| Bereavement grant | $600 |
| Osteopath per year | $340 |
| Radiation oncology | $55,000 |
| Osteopath per visit | $170 |
| Home nursing per year | $720 |
| Urodynamic assessment | $900 |
| Chiropodist podiatrist | $240 |
| Home nursing per visit | $120 |
| Post operative therapy | 1,000 per surgical event, cycle of chemotherapy and/or radiation oncology (combined maximum) |
| Gp after hours per year | $100 |
| Physiotherapy per visit | $40 |
| Specialist consultation | $4,000 |
| Spinal surgery lifetime | $200,000 |
| Gp after hours per visit | $50 |
| Mental health outpatient | $1,000 |
| Overseas transplant grant | $4,000 |
| Laboratory tests per visit | $100 |
| Prescriptions user charges | $240 |
| Cardiac diagnostic combined | $1,200 |
| Minor skin lesions per year | $1,100 |
| Non pharmac drugs inpatient | $330 |
| Obstetrics loyalty per year | $300 |
| Psychiatric hospitalisation | $3,500 |
| Parent accommodation per year | $500 |
| Minor surgery gp per admission | $400 |
| Non pharmac chemotherapy drugs | $8,500 |
| Parent accommodation per night | $100 |
| Dietitian nutritionist per year | $160 |
| Dietitian nutritionist per visit | $40 |
| Gastroscopy colonoscopy per year | $5,000 |
| Minor skin lesions per admission | $550 |
| Overseas treatment loyalty grant | $5,000 |
| Surgical admission per admission | $100,000 |
| Minor surgery specialist per year | $1,210 |
| Non acute medical hospitalisation | $3,500 |
| Non pharmac drugs general medical | $330 |
| Acute private hospitalisation grant | $2,500 |
| Public hospital cash grant per year | $1,680 |
| Prophylactic surgery loyalty lifetime | $25,000 |
| Surveillance colonoscopy per 24 months | $2,500 |
| Surveillance following cancer per year | $3,000 |
| Public hospital cash grant per 24 hours | $150 |
| Breast symmetry post mastectomy lifetime | $6,500 |
| Oral surgery rooms surgeon per admission | $720 |
| Psychiatric consultations loyalty per year | Three Visits |
| Oral surgery hospital surgeon per admission | $720 |
| Oral surgery hospital theatre per admission | $2,000 |
| Psychiatric consultations loyalty per visit | $150 |
| Oral surgery rooms anaesthetist per admission | $360 |
| Oral surgery hospital anaesthetist per admission | $360 |
| Oral surgery hospital accommodation per admission | $6,400 |
| Obesity or breast reduction surgery loyalty lifetime | $4,000 |
What does UniCare Advantage not cover?
- 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.
All UniMed exclusions side by side: UniMed exclusions.
How does UniCare Advantage handle Pharmac drugs, ACC, mental health and pre-existing conditions?
Pharmac vs non-Pharmac drug cover
Pharmac-approved chemotherapy drugs are covered under the Chemotherapy benefit (up to $55,000 per policy year). Non-Pharmac chemotherapy drugs that are Medsafe approved for the treatment of cancer are covered up to $8,500 per annum within the Chemotherapy benefit. Non-Pharmac subsidised pharmaceuticals (prescribed by a Registered Medical Practitioner, approved by Medsafe, and not fully or partly subsidised by Pharmac through the New Zealand Pharmaceutical Schedule) are covered up to $330 per policy year under both the In-Patient Non-Pharmac Subsidised Pharmaceuticals benefit and the General Medical Expenses Non-Pharmac Subsidised Pharmaceuticals benefit. User part charges for prescription items on the New Zealand Pharmaceutical Schedule are covered up to $240 per policy year.
ACC interaction
For Accident Surgery, UniMed must receive written confirmation from ACC regarding their decision to accept or decline the claim before qualifying surgical procedures are undertaken. If ACC accepts the claim, UniMed provides 'top-up' coverage to the benefit levels applicable to the Private Hospitalisation Surgical Benefits section. If ACC declines the claim, UniMed will, at its sole discretion, either assist with the total cost of surgery or pay the difference between the actual cost of surgery and what ACC would have contributed had the claim been accepted. For non-hospital ACC top-up, the shortfall between actual costs and ACC refunds for out-of-hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits shown under the General Medical Expenses and Minor Surgery benefit sections; ACC must have provided financial assistance towards treatment costs for a claim to qualify.
Mental health cover
Annual sublimit: $1,000
Psychiatric Hospitalisation in a Licensed Private Hospital on admission and under the care of a Specialist Psychiatrist. Refund of Hospital Accommodation Fees and ancillary hospital charges up to $3,500 per policy year. Under the Loyalty Benefits (after five years' continuous membership), consultations with a vocationally registered psychiatrist in New Zealand are covered at $150 per visit up to three visits per policy year.
IVF and assisted reproduction
IVF is not mentioned as a covered benefit. No explicit IVF benefit is described in the policy wording.
Oncology and high-cost cancer drugs
Non-Pharmac chemotherapy drugs that are Medsafe approved for the treatment of cancer are covered up to $8,500 per annum, included within the overall Chemotherapy benefit of $55,000 per policy year. Genetic/genomic testing is also included, payable following a cancer diagnosis and referral by a Registered Oncologist.
Gap payment rules
Payments under the Private Hospitalisation Surgical Benefits section are limited to 80% of the Reasonable charges of the procedure up to the per admission limit stated. All benefit sections from the Public Hospital Benefits section forward refund 80% of actual medical costs to the specified maximums. The General Medical Expenses section also refunds 80% of actual medical costs to the specified maximums. All benefits are inclusive of GST charged by healthcare providers.
Get a quote for UniCare Advantage
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More on UniCare Advantage
- Wording change history
- UniMed review (all plans)
- Machine-readable: facts.json · wording.md
Other UniMed plans: Health Positive · Hospital Select · ParentStay