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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. |
16-70
(individual consideration from age 70) |
All |
Yearly renewable to age 100 |
Direct Debit, Credit Card |
Monthly, Yearly |
Specialist & Tests |
Yes, one additional premium for all children |
$Nil, $300, $600, $1200, $2000, $4000 |
Per person per policy year |
Policy fee waived for second life |
Premiums based on age |
Premiums are reviewed quarterly with changes applied on the yearly anniversary of your policy |
New Zealand only |
| 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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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 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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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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| This benefit provides coverage for medically necessary angiograms, MRI and CT scans, regardless of whether surgery is performed or not. |
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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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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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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 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 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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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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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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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 - 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 |
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 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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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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