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Health Insurance Product Comparisons
While every effort has been made to ensure all information below is accurate & up to date, you should always refer to the the full policy document for each provider for the full information on each benefit
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Premier Health is a flexible health policy that can be tailored to help suit you and your family's needs and budget. And the good thing is, you can change your policy as you move through the different stages of life.
At the heart of your Premier Health policy is the Base Cover. We then offer a range of options that you can choose individually or any combination of, to customise a policy that best suits you.
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If you, or a member of your family, require surgery or medical treatment, Sovereign Absolute Health not only gives you the freedom to select the best specialists and the best hospitals, it generally ensures that you avoid a huge waiting list to receive essential treatment. This gives you greater certainty about the most important thing we need to protect – our health. |
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16-70
(individual consideration from age 70) |
16-70
(individual consideration from age 70) |
All |
All |
Lifetime |
Yearly renewable to age 100 |
Direct Debit, Credit Card |
Direct Debit, Credit Card |
Monthly, Yearly |
Monthly, Yearly |
Specialist, GP Cover, Dental & Optical, Lump Sum Trauma |
Specialist & Tests |
Yes, additional premium is based on number of children |
Yes, one additional premium for all children |
$Nil, $250, $500, $1000, $2000, $4000, $6000 |
$Nil, $300, $600, $1200, $2000, $4000 |
Per Claim |
Per person per policy year |
2.5% for having more than one person on a policy |
Policy fee waived for second life |
Premiums based on age |
Premiums based on age |
Premiums are reviewed quarterly with changes applied on the yearly anniversary of your policy |
Premiums are reviewed quarterly with changes applied on the yearly anniversary of your policy |
New Zealand only |
New Zealand only |
| Click an item to show/hide further details |
TOWER Health & Life cover the cost of surgery requiring an anaesthetic in an approved private hospital. Surgery includes (for
example, without limitation): general and cancer surgery, cardiac surgery, orthopaedic surgery, laparoscopic
surgery, oral surgery, angiography, angioplasty and lithotripsy.
TOWER Health & Life also cover the cost of intensive nursing care, x-rays, disposables and consumables, dressings, and drugs
listed under Sections A to G of the PHARMAC Pricing Schedule, where they meet PHARMAC?s funding
criteria, etc.
Diagnostic investigations
TOWER Health & Life cover the cost of diagnostic investigations requiring an anaesthetic in an approved private hospital.
Diagnostics covered include (for example, without limitation): endoscopy, gastroscopy, colonoscopy and
cystoscopy. |
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| Covers reasonable charges incurred during a surgical hospitalisation when referred by a specialist including:
• Surgeon fees
• Anaesthetist fees
• Diagnostic fees
• Hospital fees including:
- Accommodation
- Operating theatre fees
- Ancillary hospital charges including: anaesthetic supplies, dressings, pathology tests, ECG, post operative physiotherapy, medication (prescribed and taken while in hospital)
- Disposable laparoscopic equipment (separate maximum cover may apply)
- Prostheses (separate maximum cover may apply).
Also covers reasonable charges incurred for the following procedures where the procedure is performed on a life assured admitted overnight to a private hospital, when recommended by a specialist:
• Arthroscopy
• Dilatation & Curettage
• Hysteroscopy
• Laproscopy |
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TOWER Health & Life cover the cost of medical treatment (not involving surgery) in an approved private hospital. Medical
treatments covered include (for example, without limitation): heart disease, treatment of respiratory disease
(asthma, pneumonia, etc) and treatment for endocrine disease (diabetes, etc).
TOWER Health & Life also cover the cost of intensive nursing care, x-rays, disposables and consumables, dressings and drugs
listed under Sections A to G of the PHARMAC Pricing Schedule where they meet PHARMAC?s funding criteria,
etc.
Cancer Treatment Benefit
TOWER Health & Life cover the cost of the chemotherapy agent(s) and radiotherapy (where this is available privately in New
Zealand) used in a cycle of treatment for cancer administered outside the public health system, including the
cost of a registered specialist or health service provider to administer these treatments.
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Covers reasonable charges incurred during a medical hospitalisation for treatment of a condition which does not require surgery when referred by a specialist including:
• Hospital Accommodation fees
• Physician/Specialist fees
• Diagnostic fees
• Ancillary hospital fees: including, but not limited to, materials and medication prescribed while in hospital; Physiotherapist fees.
Non-surgical hospitalisations include, but are not limited to, admissions for treatment (other than surgery) of asthma, diabetes, stroke, cancer and oncology radiology/ chemotherapy treatment, lithotripsy or any other acute chronic illness.
Pharmaceutical treatment costs covered under this benefit are limited to subsidised prescription drugs specified in the New Zealand Pharmaceutical Schedule (as published by Pharmac) or any replacement schedule. |
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■ Covers Oral Surgery by a registered oral and maxillo-facial surgeon.
■ Only covers removal of unerupted and impacted teeth if a registered oral surgeon or registered dentist performs
the procedure.
■ Does not cover any other dental treatments including periodontal, orthodontic and endodontal procedures and implants.
■ A 12-month stand-down period from the join date of each insured person applies to the extraction of
wisdom teeth |
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Covers reasonable charges of medically necessary oral surgery*, performed by an oral surgeon, when referred by a registered medical practitioner including:
• Oral Surgeon Fees
• Anaesthetist Fees
• X-rays
• Hospital or day stay clinic charges (if applicable)
• Ancillary charges including: dressings, medication
(prescribed immediately post surgery), anaesthetic
supplies.
* Oral surgery procedures covered are:
• Removal of impacted wisdom teeth
• Removal of unerupted teeth
• Treatment of cysts, soft tissue swellings and
enlargements.
Cover is not provided for root canal treatment, dental repair or implants. Cover is also not provided for orthodontic treatment or orthognathic surgery of any kind. |
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■ Associated Oncology and Diagnostic Radiology and Imaging Benefit
Covers the cost of:
Registered specialist consultations, Diagnostic radiology, Diagnostic imaging such as x-rays, ultrasound, mammography, scintigraphy, MRI and CT scans
resulting from a referral by a GP or registered specialist where the registered specialist consultation, diagnostic
radiology or diagnostic imaging directly relates to, or results in, the insured person having private
chemotherapy or radiotherapy treatment for cancer which has been paid for under this policy.
■ Hospital Related Specialist Consultations Benefit
Covers the cost of registered specialist consultations up to six months prior to admission to an approved
private hospital and up to six months after being discharged from that approved private hospital where those
visits directly relate to that hospitalisation, after a referral from a GP or a registered specialist.
■ Hospital Related Diagnostic Radiology and Imaging Benefit
Covers the cost of diagnostic radiology and diagnostic imaging such as x-rays, ultrasound,
mammography, scintigraphy, MRI and CT scans up to six months prior to admission to an approved
private hospital and up to six months after being discharged from that approved private hospital,
where those diagnostic procedures directly relate to that hospitalisation, after a referral from a GP or
a registered specialist.
■ Hospital Related Cardiac Investigations Benefit
Covers the cost of cardiac investigations such as treadmills, holter monitoring, ambulatory blood
pressure monitoring, cardiovascular ultrasound, echocardiography, myocardial perfusion scans and
cardioversion up to six months prior to admission to an approved private hospital and up to six
months after being discharged from that approved private hospital, when those investigations
directly relate to that hospitalisation, after a referral from a GP or a registered specialist.
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Covers reasonable charges of specialist consultations and diagnostic procedures directly relating to a medical condition covered above and when referred by a specialist.
Period covered is for three months before, and three months after, a covered medical hospitalisation or surgery.. |
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Covers the cost of MRI and CT scans if a registered specialist recommends the scan, even when the insured person has not been, or will not be, hospitalised.
Benefit Maximum:
MRI Scan - up to $2,500 per policy year, less any excess
CT Scan - up to $2,000 per policy year, less any excess
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| This benefit provides coverage for medically necessary angiograms, MRI and CT scans, regardless of whether surgery is performed or not. |
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TOWER Health & Life cover the cost of treatment for minor surgery, performed by a registered specialist, on referral from a GP.
Benefit maximum
TOWER Health & Life pay up to $6,000 per policy year, less any excess.
TOWER Health & Life cover the cost of treatment for minor surgery on skin lesions performed by a registered specialist, on
referral from a GP.
Note
TOWER Health & Life recommend pre-approval as some minor surgery is deemed cosmetic surgery and is not covered
This Benefit does not include the pre and post minor surgery specialist consultations, or any other
diagnostic costs associated with treatment.
Skin Lesions
TOWER Health & life cover the cost of treatment for minor surgery on skin lesions performed by a registered specialist, on
referral from a GP.
Benefit maximum
All costs paid under this Benefit are included within the Benefit maximum for the Specialist Minor Surgery Benefit.
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Covers reasonable charges incurred with an outpatient surgical procedure when recommended by a specialist (including related diagnostic testing performed in connection with the procedure).
This benefit provides coverage for medically necessary angiograms, MRI and CT scans, regardless of whether surgery is performed or not. This benefit also covers reasonable charges incurred for the following procedures when recommended by a specialist:
• Arthroscopy
• Cystoscopy
• Colonoscopy*
• Dilatation & Curettage
• Gastroscopy
• Hysteroscopy
• Laproscopy
• Myleogram
*Cover is not provided for routine screening or periodic testing.
Benefit Maximums:
$100,000 per life assured, per policy year - Excess applies |
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TOWER Health & Life cover the cost of post-treatment home nursing care by a registered nurse, up to six months after being
discharged from an approved private hospital, on referral by a GP or registered specialist or up to six months
after a cycle of chemotherapy or radiotherapy treatment.
Benefit maximum
Up to $150 per day.
Up to $6,000 per policy year. |
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Covers reasonable charges of home care provided by a registered nurse when recommended by a specialist.
This care must immediately follow discharge from a private hospital for a covered surgical or medical procedure.
Benefit Maximum:
Up to $125 per day
Up to $2,500 per year per life assured per policy year |
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TOWER Health & Life cover the cost of post-treatment physiotherapy up to six months after being discharged from an
approved private hospital on referral by the treating registered specialist or up to six months after a cycle of
chemotherapy or radiotherapy treatment.
Benefit maximum
No limit per visit.
TOWER Health & Life pay up to $500 per hospitalisation or per cycle of chemotherapy or radiotherapy treatment. |
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TOWER Health & cover the cost of treatment associated with an abnormal pregnancy and/or childbirth, but
excluding caesarean sections and ectopic pregnancies.
Benefit maximum
We pay up to $2,000 per policy year, less any excess. |
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TOWER Health & Life cover any shortfall between what ACC pays for a physical injury and the actual costs covered of
the surgical and/or medical treatment in an approved private hospital, less any excess. This is limited
to the appropriate Benefit maximum, less any excess. A copy of ACC?s decision must be supplied to
us prior to treatment being undertaken.
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TOWER Health & Life cover the cost of surgical or medical treatment that cannot be performed at all in New Zealand, and
reasonable travel cost, where the Ministry of Health provides partial funding, but that funding does not cover
the full cost.
Benefit maximum
Up to $20,000 per overseas visit for treatment, less any excess.
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Covers reasonable charges for medical treatment at an overseas hospital acceptable to Sovereign, where medical treatment covered under this policy cannot be provided in New Zealand.
A specialist must recommend the medical treatment and approval of the claim must be received from Sovereign prior to the medical treatment.
This benefit also includes two return economy class airfares for the life assured and a support person.
Benefit Maximums:
$20,000 per life assured, per lifetime - Excess applies |
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This Benefit applies where a GP or registered specialist has recommended treatment and where that
treatment cannot be performed in the insured person?s local approved private hospital.
Rail or road travel
TOWER Health & Life cover the cost of rail or road travel within New Zealand where the nearest approved private hospital is
more than 100km one way from the insured person?s usual residence. We will reimburse the cost of mileage
for road travel, at the amount determined by us from time to time, to and from the nearest approved private
hospital, or the cost of return transport by rail or bus to and from the nearest approved private hospital.
Air travel
TOWER Health & Life cover the cost of a return economy airfare within New Zealand for the insured person requiring treatment
and for a support person to travel to and from an approved private hospital. This Benefit applies where a GP
or registered specialist has recommended treatment and where that treatment cannot be performed in the
insured person?s local approved private hospital.
Accommodation
TOWER Health & Life cover the cost of accommodation incurred by a support person during an insured person?s hospitalisation
or cycle of chemotherapy or radiotherapy treatment.
Benefit maximum
Rail or road travel
TOWER Health & Life pay up to $1,800 per hospitalisation or per cycle of chemotherapy or radiotherapy treatment for the cost
of mileage, at the amount determined by us from time to time, or for the cost of a return rail or bus trip.
Air travel
TOWER Health & Life pay the cost of a return economy airfare within New Zealand for the insured person requiring treatment
and one support person. We also pay the taxi fares from the airport of arrival to the approved private hospital
(on admission) and from the approved private hospital (on discharge) to the airport of departure. This applies
per hospitalisation or per cycle of chemotherapy or radiotherapy treatment.
Accommodation
Up to $150 per night for the accommodation costs incurred by the support person
Up to $1,800 per hospitalisation or per cycle of chemotherapy or radiotherapy treatment. |
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This benefit specifically covers the transfer of a patient from one private hospital or day stay clinic to another private hospital or day stay clinic in a situation where complications have arisen and further treatment can only be provided by specialist services at the private hospital or day stay clinic where the patient is being transferred. The benefit only applies to transfers within the North and South Islands of New Zealand.
All reasonable charges for the following modes of transport will be met: air ambulance, road ambulance, road transport, or economy airfares.
Benefit Maximums:
$125 per day up to a maximum of $2,500 per life assured, per policy year - No excess applies |
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| Covers the cost of a road ambulance to and from an approved private hospital, within New Zealand for the
insured person for hospitalisation, if a GP or registered specialist has recommended the transfer by ambulance. |
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TOWER Health & Life cover the cost per night of the accommodation incurred by a parent or legal guardian accompanying an
insured child aged under five years listed in the acceptance certifificate or renewal certifificate, where that child
is being treated in an approved private hospital, and a Benefit under Hospital-Surgical, Hospital-Medical or Cancer Treament has been paid
Benefit maximum
Up to $150 per night.
Up to $1,800 per hospitalisation or per cycle of chemotherapy or radiotherapy treatment. |
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Covers reasonable charges of accommodation and/or transportation as required for a parent, guardian or support person who accompanies a life assured receiving a covered treatment outside their region of residence.
Benefit Maximums:
$125 per day up to a maximum of $2,500 per life assured, per policy year - No excess applies |
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If a life assured dies when aged between 21 and 59 (inclusive), Sovereign will pay a death benefit of $2,500 to the policy owner or their estate (no excess applies).. |
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TOWER Health & Life cover the premiums due on this policy for all surviving insured persons if a policyowner dies
before the age of 65 from any cause.
Benefit maximum
We pay the premiums:
For two years, or
Until any surviving insured person is aged 65,
whichever occurs first.
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Upon the death of a life assured, prior to attaining the age of 70 years, and where the cause of death is not excluded under this policy, Sovereign will continue to provide cover under this policy for the surviving lives assured covered by the policy at the time of death, without requiring further premiums for 12 months from the date of death.
Benefit Maximum: 1 years premium |
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After 12 months? continuous cover under this policy, the cover (including the premium payments) can be
suspended as follows:
Overseas travel/residence
If the insured person lives or travels outside New Zealand for longer than three consecutive months the cover
for the insured person can be suspended for between three and 24 months. To suspend cover you must tell
us in writing before the insured person travels overseas, and provide any evidence of travel we require.
Unemployment
If you are registered as unemployed, cover can be suspended for between three and six months. To suspend
cover you must tell us in writing within 30 days of you registering as unemployed and provide evidence of
registration. |
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For 3 - 24 months while an insured person lives or travels overseas for longer than 3 consecutive months.
For 3 -6 months if you are registering as unemployed (After policy is inforce for at least 12 months) . |
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TOWER Health & Life make a cash payment when an insured person is admitted to a public hospital in New Zealand and is in
the public hospital for three or more consecutive nights.
Benefit maximums
TOWER Health & Life pay $100 per night.
Up to $500 per policy year.
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Lump sum payment paid if the life assured is admitted to a public hospital for more than three days (not including admissions on a private fee paying basis or for obstetric care).
Benefit Maximums:
$200 per day up to a maximum of $2,000 per life assured, per policy year - No excess applies |
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Sterilisation Benefit - After five years? continuous cover under this policy, an insured person is covered for the cost of male or
female sterilisation as a means of contraception.
Benefit maximum
We pay up to $1,000 per procedure, less any excess.
Wellness - After an insured person aged 21 or over has been continuously covered under the Base Cover for 36 months, we
cover the cost of a medical examination of that insured person by a GP including, for example, the cost of
laboratory tests, ECG, blood pressure checks, breast examinations, cervical smears and prostate examinations.
Benefit maximum
We pay up to $100 per insured person aged 21 or over, after each 36 months of continuous cover. |
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Sterilisation Benefit - Covers reasonable charges of sterilisation including vasectomies and female sterilisation procedures (i.e. tubal ligation and hysteroscopic sterilisation). Prior approval must be received from Sovereign.
No maximum cover.
Applies only after two years of continuous cover.
Excess applies |
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Base cover excess does not apply |
Base cover excess does not apply |
| Covers the cost of registered specialist consultations, after referral by a GP or registered specialist, even
when the insured person has not been, or will not be, hospitalised.
If consultations result in admission to an approved private hospital or cycle of chemotherapy or radiotherapy
treatment within six months of the consultation, the cost of these will be covered under the Base Cover and
are included within the applicable Benefit maximum. |
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Covers reasonable charges of a specialist when referred
by a registered medical practitioner including:
Cardiac Surgeons
Cardiologists
Ear, Nose & Throat Specialists
Gastroenterologists
General Surgeons
Gynaecologists
Neurosurgeons
Oncologists
Orthopaedic Surgeons
Urologists
Cover is not provided for obstetricians, psychiatrists or psychologists. |
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Covers the cost of diagnostic radiology and diagnostic imaging tests, under the Benefit maximums below,
after referral by a GP or registered specialist, even when the insured person has not been, or will not be,
hospitalised for treatment.
Benefit maximum
TOWER Health & Life pay up to the following:
X-rays $1,200
Arteriogram $1,200
Ultrasound $500
Scintigraphy $400
Mammography $300
Benefit maximums are per policy year.
Cardiac Investigations Benefit
Covers the cost of cardiac investigations after referral from a GP or a registered specialist, even when the
insured person has not been, or will not be, hospitalised. Investigations such as treadmills, holter monitoring,
ambulatory blood pressure monitoring, cardiovascular ultrasound, echocardiography, myocardial perfusion
scans and cardioversion are included.
Benefit maximum
We pay up to $60,000 per policy year.
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Covers the reasonable charges of diagnostic procedures directly relating to a medical condition when referred by a specialist including:
Allergy Testing
Audiology
Audiometric tests
CT Scans
Colonoscopy*
Cystoscopy
Electroencephalography (EEG)
Electromyography (EMG)
Exercise ECG
Gastroscopy
Holter Monitoring
Laboratory Tests
Mammography*
MRI Scans
Myleogram
Ultrasound
Urodynamic assessments
X-Rays
*Cover is not provided for routine screening or periodic testing.
Benefit Maximums: Included as part of the maximum specialist consultation cover above |
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Covers the cost of GP visits, including home visits, ECG, cervical smears and minor surgery under local
anaesthetic.
Benefit maximums
Up to $55 per GP clinic visit, including after hours.
Up to $80 per home visit.
Up to $25 per visit for ACC Top-up. You cannot use the $55/$80 per clinic/home visit Benefit to add
to this.
Up to 12 GP visits per policy year. Minor surgical procedures are not counted in the 12 visits.
Up to $200 per minor surgical procedure. You cannot use the $55/$80 per clinic/home visit Benefit to
add to this.
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Covers the cost of medicines and drugs listed under Sections A to G of the Ministry of Health PHARMAC
Pricing Schedule prescribed by a GP or registered specialist that meet the eligibility criteria for funding.
Benefit maximums
Up to $15 per item.
up to $300 per policy year. |
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Covers the cost of physiotherapy treatment after referral by a GP or registered specialist.
Benefit maximums
Up to $40 per visit.
Up to $15 per visit for ACC Top-up. You cannot use the $40 per visit Benefit to add to this.
Up to $400 per policy year. |
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Covers the cost of visits to/by an independent nurse or nurse practitioner.
Benefit Maximums:
Up to $30 per visit.
Up to six visits per policy year. |
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After 24 months? continuous cover under the GP Option, and at the end of every 24 months thereafter,
providing claims for events that occurred within the preceding 24 month period under the GP Option are less
than $150, each insured person aged 21 or over will receive a reimbursement of the cost of either:
Membership to a recognised gym or sports club, or
Sports/fitness equipment purchased from a recognised sporting retailer.
If you submit a claim for events which occurred within the preceding 24 month period after this Benefit has
been paid, we will deduct the amount paid to you for this Active Wellness Benefit from the claim.
Benefit maximum
We pay up to $150 per insured person, aged 21 or over, after each 24 months of continuous cover under the
GP Option. |
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Base cover excess does not apply . TOWER Health & Life will refund you 80% of the cost incurred up to the benefit maximums.
Note - A six-month stand down before benefits can be claimed under this option.
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Cover not available |
Covers the cost of dental treatment by a registered dental practitioner or oral surgeon, including
examination, cleaning and scaling, fi llings, associated x-rays and removal of teeth.
Benefit maximum
We pay up to $500 per policy year. |
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Covers the cost of optometrist, orthoptist and optician examination fees and the cost of glasses and
contact lenses when these are required as a result of a vision change.
Benefit maximums
Up to $55 per consultation/examination.
Up to $275 per policy year for consultations/examinations.
Up to $330 per policy year for each insured person for glasses and contact lenses. |
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Covers the cost of audiometric tests and audiology treatment after referral from a registered specialist.
Benefit maximums
Up to $250 per policy year for audiology.
Up to $250 per policy year for audiometric tests. |
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Covers the cost of acupuncture treatment by a GP or by a registered physiotherapist, after referral from a
GP or registered specialist.
Benefit maximums
Up to $40 per visit.
Up to $15 per visit for ACC Top-up. You cannot use the $40 per visit Benefit to add to this.
Up to $250 per policy year.
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Covers the cost of chiropractic treatment after referral from a GP or registered specialist.
Benefit maximums
Up to $40 per visit.
Up to $15 per visit for ACC Top-up. You cannot use the $40 per visit Benefit to add to this.
Up to $250 per policy year for visits.
Up to $80 per policy year for x-rays. |
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Covers the cost of osteopathy treatment after referral from a GP or registered specialist.
Benefit maximums
Up to $40 per visit.
Up to $15 per visit for ACC Top-up. You cannot use the $40 per visit Benefit to add to this.
Up to $250 per policy year for visits.
Up to $80 per policy year for x-rays. |
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Covers the cost of podiatry treatment after referral from a GP or registered specialist.
Benefit maximums
Up to $40 per visit.
Up to $250 per policy year. |
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Covers the cost of speech, occupational and eye therapy after referral from a GP or registered specialist.
Benefit maximums
Up to $40 per visit.
Up to $300 per policy year for the combined total of all of these therapies. |
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After an insured person has been continuously covered under the Dental and Optical Option for 24 months,
the Dental Care Benefit will be extended to include orthodontic treatment up to the same Benefit maximums.
Benefit maximum
All costs paid under this Benefit are included within the Benefit maximum for the Dental Benefit of up to
$500 per policy year. |
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TOWER Health & Life will not pay a benefit for –
The following health conditions:
a) A health condition in connection with the misuse of alcohol and/or prescription drugs.
b) A health condition in connection with the use of non-prescription drugs.
c) A psychiatric health condition or any mental disorder and subsequent treatment.
d) A dental health condition (except where the contrary is expressly specified in this policy).
e) Senile illness or dementia.
f) Acquired immune deficiencies (AIDS) or associated health conditions including HIV and related health conditions.
g) Infection by any sexually transmitted disease and any resulting complication.
h) A known congenital health condition. (i.e. a health condition which is recognised at birth, or diagnosed within three months of birth, whether it is inherited or due to external factors such as drugs or alcohol).
i) Any health condition as a consequence of war, invasion, act of foreign enemy, hostilities or warlike operations (whether war is declared or not), civil war, civil commotion, mutiny, rebellion, revolution, insurrection, act of terrorism, act of bio terrorism, peace keeping duties, or military or usurped power.
j) Any health condition not registered with the Ministry of Health as a disease entity.
k) Any pre-existing condition. This exclusion does not apply, however, in respect of a health condition declared on your application form and accepted by TOWER Health & Life.
l) Any acute health condition.
m) A health condition arising from a criminal offence by an insured person that resulted in a conviction.
n) Infertility, normal pregnancy and childbirth, termination of pregnancy, erectile dysfunction, sterilisation, contraception
or contraceptive procedures (except where the contrary is expressly specified in this policy).
The following tests, diagnostic procedures, treatments, or health services:
a) Geriatric care including geriatric hospitalisation or long term care.
b) Breast reduction.
c) The treatment of obesity.
d) Rehabilitation, convalescence, respite, disability support services costs (except where the contrary is expressly stated
within this policy).
e) Cosmetic treatment or elective treatment which does not improve an insured person’s health.
f) Preventative treatment and surveillance testing except where provided for under a Wellness Benefit.
g) Any investigation and/or treatment for sleep disturbances, snoring or obstructive sleep apnoea.
h) Treatment for self-inflicted injuries or attempted suicide.
i) Any services or treatment not normally conducted by a GP or registered specialist, and/or not recognised by the Medical Council of New Zealand or Ministry of Health (except where the contrary is expressly stated within this policy).
j) Specialised tertiary treatments such as heart, lung, kidney, liver and bone marrow transplants as provided by government funded agencies.
k) Specialised transfusions of blood, blood products, renal dialysis or CAPD as provided by government funded agencies.
l) Any treatment for the correction of myopia (short sightedness) or hypermetropia (long sightedness), or presbyopia (blurred vision) or any related complications except where provided for under the Dental Benefit.
m) Radial keratotomy or photo-retractive keratectomy or any related complications.
n) Any costs incurred as a result of cancellation of treatment under one of the eligible benefits except where that cancellation is on medical advice.
o) Costs incurred outside New Zealand (except where expressly specified otherwise in this policy).
The cost of:
a) Mechanical tools as determined by TOWER Health & Life. For example (without limitation): glucometers, oxygen machines, and respiratory machines.
b) Aids as determined by us. For example (without limitation): hearing aids, personal alarms, and orthotic shoes.
c) Appliances to assist with mobility as determined by TOWER Health & Life. For example (without limitation): crutches, wheelchairs, and artificial limbs. This does not include surgically implanted prostheses.
Cost and expenses recovered or recoverable from a third party or under any other contract of indemnity or insurance.
The cost of treating a physical injury or medical misadventure except as provided under the ACC top-up benefit. Where no ACC top-up maximum is specified, the amount TOWER Health & Life pay is the lesser of the actual costs of the treatment or the health plan benefit maximum, less the amount payable by ACC. Where the benefit maximum is subject to a maximum percentage of actual costs, eg 80%, this amount is subject to that maximum percentage.
Medicines or drugs that are not listed on the PHARMAC Schedule.
Any costs for a health condition that arose during a stand-down period. Stand-down periods do not apply to newborn dependent children added to the policy within 4 months of birth. |
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Sovereign will not pay any expenses incurred in relation to, or as a consequence of, any of the following:
• An existing condition unless the symptom or condition was disclosed at the time of your
application and accepted in writing by Sovereign;
• Any congenital conditions;
• Reconstructive or reparative procedures or surgery, which results from, or which is traceable to, or
is medically related to, any surgery performed prior to the risk commencement date;
• Any elective or cosmetic procedures and associated treatments (including, for example, surgery
for breast enlargements, facelifts, varicose veins);
• Breast reduction surgery and gynaecomastia;
• Acne treatment, except where classified by a specialist as Grade 4 acne with serious medical
implications;
• The misuse of prescribed or non-prescribed drugs, including where they have not been taken in
accordance with the manufacturer’s or a registered medical practitioner’s directions;
• Certifiable mental disease or psychiatric illness or any charges relating to services resulting from a
referral to, or provided by, a psychiatrist. This includes all counselling services;
• Suicide, self-inflicted injuries or illness, or any accident, illness, condition or disability arising from,
or caused or contributed to by, drug taking, intoxication or misuse of alcohol, or nuclear
contamination;
• HIV related disorders, including AIDS;
• Obstetric visits, pregnancy, childbirth, abortion, or any conditions or complications arising from
any of the foregoing;
• Contraception of any type;
• Diagnosis, management and treatment of infertility;
• Circumcision, except where medically necessary;
• Diagnosis, management and treatment of snoring, except where a specialist confirms diagnosis of
sleep apnoea and the surgical treatment is medically necessary. (Pre-approval of any claim for
treatment must be sought or obtained from Sovereign before any costs are incurred);
• Any geriatric or dementia conditions, including disability support services;
• New medical treatments, procedures or technologies that have not been approved by Sovereign;
• Treatment requiring periodontal, orthodontic, endodontal or cosmetic procedures, including, but
not limited to, conditions arising out of neglect of dental services;
• Sterilisation (except as provided under the Loyalty Benefit);
• Any surgery for the correction of refractive visual errors;
• Preventative treatment, or treatment or investigation of any condition that will not cause significant
problems for the health of the individual if medical treatment is not received (including, for
example, routine screening or mole mapping);
• Treatment for obesity (including treatment of complications arising from any treatment for obesity);
• Renal dialysis;
• Injuries of war or resulting from any terrorist act (whether war is declared or not);
• Organ donation and receipt;
• Charges for a treatment or procedure not provided by a registered medical practitioner practicing
within his or her scope of practice;
• Treatment provided by a public hospital, except where expressly covered by this policy;
• Physiotherapist’s, chiropractor’s, osteopath’s, naturopath’s, homeopath’s, acupuncturist’s, and
podiatrist’s costs;
• Nursing costs, except where expressly covered by this policy;
• Prescription charges, except where expressly covered by this policy;
• Any charge incurred for non-essential or personal items (for example, newspapers, spouse/family
meals, alcohol, TV rental);
• Surgical, medical or dental appliances, other than surgical prostheses specified in this benefits
sheet, including, but not limited to, cardiac pacemakers, nerve appliances, cochlear implants, bite
splints and orthotics;
• Any condition arising from participation in a criminal act;
• Any condition specifically excluded in the policy document;
• Costs for treatment carried out outside of New Zealand (except where expressly covered under
the Overseas Medical Treatment benefit);
• Palliative Care.
• Sovereign will not pay any part of a claim that you make under this policy to the extent that you
are able to recover from sources outside of this policy, including any other contract of insurance,
regardless of whether you claim from these other sources or not.
• Sovereign will not pay any benefit under this policy for any additional surgery performed during
any operation, which is not directly related to any medical condition or treatment covered under
the terms of this policy.
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While every effort is made to ensure all of the information presented on this site is correct & up to date, no liability will be taken for any errors or omissions. Please refer to the full policy document for full information
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www.pensiontransfers.co.nz
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