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Sovereign Absolute Health Benefits
Health insurance policies help protect you against the more costly expenses of private hospitalisation and surgery, which can have a big financial impact. These are examples of the types of costs normally covered under health insurance policies:
- Surgical costs including surgeon's fees and anaesthetist fees
- Hospital charges in relation to confinements required for medical illness or surgery
- Specialist Visits (Optional Extra)
- Diagnostic Testing (Optional Extra).
This means that lesser day-to-day healthcare costs, such as visits to your GP, are funded by you, and the more unpredictable and significant costs, such as surgery and hospital confinement, are taken care of under your insurance cover. This results in lower premiums for you!
Sovereign Absolute Health
This is a traditional major medical insurance product. It can provide cover for individuals or the whole family. It is one of the best health insurance products on the market in terms of benefits offered and services provided, and is priced competitively.
Absolute Health Benefits
This policy provides 100% reimbursement of covered reasonable charges* incurred as a result of a medically necessary procedure up to the maximum cover amounts indicated below. This reimbursement is subject to the exclusions set out in this benefits sheet and may be subject to the application of an excess. The excess applies once per life assured per policy year. The excess applies to all benefits, except those benefits for which the excess is specifically excluded in this benefits sheet.
You may add a Specialist and Diagnostic Testing benefit, providing reimbursement for medically necessary consultations with specialists and expenses associated with diagnostic Diagnostic Testing, imaging or monitoring as indicated.
Please note, this is a summary of the benefits of this policy. For the terms and conditions of this policy please refer to the separate policy document.
*Reasonable charges are determined based on Sovereign's claim statistics.
Prior Approval Service: Sovereign recommends that you seek Sovereign's approval prior to incurring costs related to any medical treatment to ensure that the medical treatment is covered under this policy.
| Benefit | Covered Expenses | Maximum Cover |
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| Medical Hospitalisation in a Private Hospital |
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 NZ Pharmaceutical Schedule (as published by Pharmac) or any replacement schedule. |
$250,000 per Life Assured per policy year
Includes Pre Admission & Post Discharge as below
Excess applies |
| General surgery performed in a Private Hospital | 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, ECG, post operative physiotherapy, medication (prescribed and taken whilst in hospital
Disposable laparoscopic equipment. (separate max. cover may apply)
Prosthesis (separate max cover may apply)
Also covers reasonable charges incurred for the following procedures performed on a life assured admitted overnight to a private hospital, when recommended by a specialist:
Dilation & Curettage
Anthroscopy
Hysteroscopy
Laproscopy |
$250,000 per Life Assured per policy year
Includes Pre Admission & Post Discharge below
Excess applies |
| Cardiac surgery/procedures performed in a Private Hospital | Covers reasonable charges of cardiac surgery or non invasive cardiac procedures when referred by a specialist including:
Cardiac surgeon and Perfusionist Fees
Cardiologist and Radiologist Fees
Anaesthetist Fees
Diagnostic Fees
Hospital Fees including:
- Accommodation
- Operating theatre fees
- Intensive/coronary care unit fees
- Ancillary hospital charges including: anaesthetic supplies, dressings, pathology, ECG, post operative physiotherapy, medication (prescribed and taken whilst in hospital, stents - including drug eluting stents, angioplasty catheters.
- Cardiac prosthesis (separate max cover may apply) |
$250,000 per Life Assured per policy year
Includes Pre Admission & Post Discharge below
Excess applies |
| Oral surgery performed in a private hospital or day stay clinic |
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 (procedure is only covered from 12 months after commencement of this cover)
- removal of unerupted teeth (procedure is only covered from 12 months after commencement of this cover)
- treatment of cysts, soft tissue swellings
Cover is not provided for root canal treatment, dental repair or implants. Cover is also not provided for orthodontic treatment or orthonathic surgery of any kind.
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$250,000 per Life Assured per policy year
Includes Pre Admission and Post Discharge below
Excess Applies |
| Pre Admission and Post Discharge from a private hospital or day stay clinic |
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 six months before and six months after a covered medical hospitalisation or surgery. |
Included as part of the above hospitalisation or surgery maximum cover |
| Outpatient Care received at a private hospital, day stay clinic or specialist rooms approved by Sovereign |
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 in the following procedures when recommended by a specialist:
Anthroscopy
Cystoscopy
Colonoscopy
Dilation & Curettage
Gastroscopy
Hyteroscopy
Laproscopy
Mlelogram
Cover is not provided for routine screenings or periodic testing. |
$100,000 per life assured per policy year
Excess applies |
| Breast reconstruction after mastectomy |
Covers reasonable charges of breast reconstruction after total mastectomy when referred by a specialist
Cover is not provided for prophylactic procedures |
Up to $15,000 per life assured, per lifetime.
Excess applies |
| Non-Specialist Outpatient Minor Surgery |
Covers reasonable charges incurred with any of the following outpatient surgical procedures performed by a registered medical practitioner under local anaethesia in general practice surgery rooms.
This benefit only provides coverage for medically necessary:
A
- Excision of lesions, moles and cysts: and
- Wedge resection of toenails
B
- Vasectomy - only applies after two continuous years of cover:
- Allergy desensitisation injections; and
- Varicose vein treatment |
A
$250 per life assured per treatment to a maximum $500 per life assured per policy year
B
$450 per life assured per treatment to a maximum $900 per life assured per policy year
No excess applies |
| Home Nursing Care |
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. |
$150 per day up to a maximum of $5,000 per life assured per policy year
No excess applies |
| Overseas Medical Treatment |
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. |
$20,000 per life assured per life tome
Excess applies |
| Transfer Benefit |
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. |
No maximum cover
No excess applies |
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| Bereavement Grant |
If a life assured dies when aged between 21 and 59 (inclusive), Sovereign will pay a death benefit of $2,500 to the policv owner or their estate (no excess applies). |
No excess applies |
| Caregiver Accommodation |
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. |
$125 per day up to a maximum of $2,500 per life assured, per policy year
No excess applies |
| Public Hospital Cash Grant |
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).
For the purposes of this grant a "day" must include an overnight stay. |
$200 per day after the third day, up to a maximum of $2,000 per life assured, per policy year
No excess applies |
| Waiver of Premium |
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. | |
| Loyalty Benefit: Sterilisation |
Covers reasonable charges of sterilisation including vasectomies and female sterilisation procedures (Le. 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 |
| Medical Misadventure Benefit |
If during the course of any medical procedure or treatment in a private hospital, a life assured should die directly as a consequence of any erroneous or negligent action, ommision or failure to observe reasonable and customary standards by a care provider of said hospital, a death benefit shall become payable, provided:
- the death occurs within 30 days of such a recorded and proven incident; and
- a public admission of such incident and liability is made by the said hospital and verified and confirmed by the relevant Governemnt Authority, a court of law, coroners inquest or Medical Council of New Zealand; and
- the death is independent of any other cause other than the termination of the life support system after brain death has been established |
$30,000 per life assured. |
Additional Option - Specialist and Diagnostic Testing Benefit
This option, if selected, provides supplementary cover to the lives assured. It incurs additional premiums associated with the increase in benefits. No excess applies to these benefits.
What isn't covered?
To keep premiums affordable, all insurance policies contain some conditions and charges for medical services, which are not covered. For example, here are a few of ours:
- Routine physical examinations
- Prescription charges
- A pre-existing condition, unless the symtom or condition was disclosed at the time of your application and accepted in writing by Sovereign.
- Any congenital conditions
- Cosmetic surgical procedures
- Certifiable mental diseases or illnesses
- HIV related disorders, including AIDS
- Reconstructive or reparative procedures relating to an existing condition
- Illness or injury resulting from:
- Deliberate self-injury or participation in a crime
- The influence of alcohol or non-prescription drugs
- Nuclear contamination
- The misuse of prescribed drugs
- War or terrorism
- Renal dialysis
- Mole mapping
For full details on exclusions see the Benefit policy wording.
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