ACC accepted your claim — what does private cover add?
ACC top-up cover, specialist-gap, faster surgical pathway, and robotic surgery when ACC won't fund it.
You've had an accident, ACC has accepted the claim, and you want to know what private health insurance actually adds. ACC funds the procedure but: timeline can be long, surgeon choice is limited, robotic/advanced techniques may not be ACC-funded, and specialist gap fees are yours. Private cover closes those gaps.
Top policies for this scenario
Ranked by aggregate semantic match across 5 scenario-specific queries. Score reflects clause-level fit, not premium. We don't know what you'd pay — get a quote for the shortlist.
- score 1.65
#1 · AA Health
AA Private Hospital Cover
Watch out for
- If ACC accepts, your private cover usually only pays the GAP (specialist top-up, room upgrade, faster scheduling) — not the headline surgical amount. Read the ACC clause carefully.
Show matched clauses (4)
Query: "private surgical pathway when ACC funds procedure" · similarity 57% · weight 0.9
2. Your Base Cover > I need to stay in hospital for surgery or treatment > ACC Treatment Injury Benefit > What am I covered for?
If you become injured during a **health service** that we've paid for, we'll pay for the **surgery** or treatment needed to treat or repair your injury that is not covered by **ACC**.
Source PDF →Query: "choice of surgeon private hospital cover" · similarity 62% · weight 0.7
2. Your Base Cover > I need to stay in hospital for surgery or treatment > Surgical Benefit > What am I covered for?
If you're **admitted** to a **private hospital** for **surgery**, we'll pay for your treatment including your hospital stay, your **surgical** and anaesthetist costs, and any required prosthesis. We'll also pay for related costs that are charged for your treatment while you're in hospital, such as physiotherapy, tests, and medications administered (see "What medications can I claim for?" for more …
Source PDF →Query: "robotic surgery cover when not ACC funded" · similarity 52% · weight 0.8
2. Your Base Cover > I need financial support > ACC Top-Up Benefit > What am I covered for?
If your **ACC** claim payments don't fully cover the cost of the **surgery** or medical treatment you're having for a physical injury, we'll pay the difference.
Source PDF →Query: "physiotherapy rehabilitation gap cover" · similarity 57% · weight 0.5
2. Your Base Cover > I'm recovering from a stay in hospital > Physiotherapy Benefit > What am I covered for?
We'll pay for your **physiotherapy** treatment for up to six months after being discharged from a **private hospital**.
Source PDF → - score 1.56
#2 · Accuro
SmartCare+
Watch out for
- If ACC accepts, your private cover usually only pays the GAP (specialist top-up, room upgrade, faster scheduling) — not the headline surgical amount. Read the ACC clause carefully.
Show matched clauses (3)
Query: "ACC top-up gap cover for specialist fees" · similarity 63% · weight 1
General conditions of your policy > We don't cover claims covered by ACC > If ACC agrees to partially pay
Under the ACC partial payment option, you'll have to contribute to the cost of the healthcare services. We'll cover the difference in cost up to the *Reasonable charges* for this procedure or treatment, or up to the benefit limit in your policy, whichever is less. The treatment or procedure must be covered under your policy. **For example, you have an accident and need an x-ray. If ACC agreed to …
Source PDF →Query: "private surgical pathway when ACC funds procedure" · similarity 58% · weight 0.9
Hospital and Surgical+ base plan > Other benefits > ACC top-up
**An excess applies to this benefit** We cover any shortfall between what ACC pays and the actual costs of the surgical procedure or medical treatment in an approved private hospital or facility. We deduct the excess, which you must pay. You must send us a copy of ACC's decision before getting treatment. These other terms apply. - The Member must receive ACC's acceptance of their claim before t…
Source PDF →Query: "robotic surgery cover when not ACC funded" · similarity 52% · weight 0.8
Hospital and Surgical+ base plan > Standard benefits: > General surgery
**$500,000 for each person in a policy year** **An excess applies to this benefit** If you're wanting to *claim* under this benefit, we strongly recommend you seek prior approval before your treatment. This benefit covers the costs of *Reasonable charges* associated with the surgical treatment of a non-acute medical condition. The benefit covers the procedure(s) and all subsequent treatment or …
Source PDF → - score 1.52
#3 · Accuro
SmartCare
Watch out for
- If ACC accepts, your private cover usually only pays the GAP (specialist top-up, room upgrade, faster scheduling) — not the headline surgical amount. Read the ACC clause carefully.
Show matched clauses (3)
Query: "ACC top-up gap cover for specialist fees" · similarity 60% · weight 1
What we will pay > How policy benefit limits affect your claim > Example
For example, if you had an x-ray that cost $110 and ACC agreed to cover $60 of it, we would only be able to assess reimbursement of the remaining $50 under your Specialist module.
Source PDF →Query: "private surgical pathway when ACC funds procedure" · similarity 58% · weight 0.9
Hospital and Surgical base plan > Standard benefits: > General surgery
**$300,000 for each person in a policy year** **An excess applies to this benefit** If you're wanting to claim under this benefit, we strongly recommend you seek prior approval before your treatment. This benefit covers the costs of Reasonable charges associated with the surgical treatment of a non-acute medical condition. The benefit covers the procedure(s) and all subsequent treatment or expe…
Source PDF →Query: "robotic surgery cover when not ACC funded" · similarity 51% · weight 0.8
Hospital and Surgical base plan > Standard benefits: > General surgery
**$300,000 for each person in a policy year** **An excess applies to this benefit** If you're wanting to claim under this benefit, we strongly recommend you seek prior approval before your treatment. This benefit covers the costs of Reasonable charges associated with the surgical treatment of a non-acute medical condition. The benefit covers the procedure(s) and all subsequent treatment or expe…
Source PDF → - score 1.52
#4 · Accuro
StaffCare
Watch out for
- If ACC accepts, your private cover usually only pays the GAP (specialist top-up, room upgrade, faster scheduling) — not the headline surgical amount. Read the ACC clause carefully.
Show matched clauses (3)
Query: "ACC top-up gap cover for specialist fees" · similarity 60% · weight 1
What we will pay > How policy benefit limits affect your claim > Example
For example, if you had an x-ray that cost $110 and ACC agreed to cover $60 of it, we would only be able to assess reimbursement of the remaining $50 under your Specialist module.
Source PDF →Query: "private surgical pathway when ACC funds procedure" · similarity 57% · weight 0.9
General conditions of your policy > We don't cover claims covered by ACC
ACC is New Zealand's accident compensation scheme, which provides cover if you're injured. Your StaffCare Health Plan has been set up to complement this and won't cover claims related to accidents that ACC covers. If ACC doesn't cover the full amount for your treatment, we may be able to pay the difference if you have cover for this treatment under your policy. Special conditions apply to surgery…
Source PDF →Query: "robotic surgery cover when not ACC funded" · similarity 51% · weight 0.8
Hospital and Surgical base plan > Standard benefits: > General surgery
**$200,000 for each person in a policy year** **An excess applies to this benefit** If you're wanting to claim under this benefit, we strongly recommend you seek prior approval before your treatment. This benefit covers the costs of Reasonable charges associated with surgical treatment. The benefit covers the procedure(s) and all subsequent treatment or expenses listed below. - Private hospita…
Source PDF → - score 1.52
#5 · Accuro
SmartStay
Watch out for
- If ACC accepts, your private cover usually only pays the GAP (specialist top-up, room upgrade, faster scheduling) — not the headline surgical amount. Read the ACC clause carefully.
Show matched clauses (3)
Query: "ACC top-up gap cover for specialist fees" · similarity 60% · weight 1
What we will pay > How policy benefit limits affect your claim > Example
For example, if you had an x-ray that cost $110 and ACC agreed to cover $60 of it, we would only be able to assess reimbursement of the remaining $50 under your Specialist module.
Source PDF →Query: "private surgical pathway when ACC funds procedure" · similarity 58% · weight 0.9
Hospital and Surgical base plan > Other benefits > ACC top-up
**An excess applies to this benefit** We cover any shortfall between what ACC pays and the actual costs of the surgical procedure or medical treatment in an approved private or public hospital or facility. We deduct the excess, which you must pay. You must send us a copy of ACC's decision before getting treatment. These other terms apply. - The Member must receive ACC's acceptance of their clai…
Source PDF →Query: "robotic surgery cover when not ACC funded" · similarity 50% · weight 0.8
Hospital and Surgical base plan > Standard benefits: > General surgery
**$150,000 for each claim** **An excess applies to this benefit** If you're wanting to claim under this benefit, we strongly recommend you seek Prior approval before your treatment. This benefit covers the costs of Reasonable charges associated with surgical treatment. The benefit covers the procedure(s) and all subsequent treatment or expenses listed below. - Private hospital or public hospit…
Source PDF →
What to watch out for
- ACC: If ACC accepts, your private cover usually only pays the GAP (specialist top-up, room upgrade, faster scheduling) — not the headline surgical amount. Read the ACC clause carefully.
- robotic: Robotic-assisted surgery is increasingly available but often NOT ACC-funded. Private cover for it is variable — confirm before assuming.
Ready to shortlist a policy for acc accepted your claim — what does private cover add??
The ranking above is mechanical clause-matching. To get a personalised shortlist with real premium quotes, take the 60-second quick-pick or talk to our FMA-licensed adviser (FSP711891).
No cost to you · FMA-licensed adviser · We earn commission from insurers if you proceed
How this ranking works
This scenario translates to 5 semantic queries (weighted). Each query runs against every NZ health insurance policy clause we've ingested (3,000+ clauses across 5 insurers). The best clause-per-product per query contributes its similarity × weight to the product's aggregate score.
Try the underlying semantic clause search to run your own queries.
This is mechanical retrieval + ranking — not personalised financial advice. The actual policy you should buy depends on factors only an FSPR-registered adviser can assess (your medical history, budget, family composition, risk tolerance). Use this to shortlist, then talk to an adviser.