Health insurance enhancements

 

Sovereign Health Insurance Enhancements
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​Who doesn’t love an upgrade?

We’re here to make sure your health cover looks after you when you need it most. Medical situations and treatments change, so it’s important our health cover does too. Read on below to see the improvements we’ve made to our health insurance products.


Supporting your families in their time of need - 14th December 2017

The background

Our health insurance Waiver of Premium on Death and Bereavement Grant benefits assist family members during a difficult time by providing some financial support. There is an exclusion which means these won't be paid out if the life assured's death is a result of a self-inflicted act.

The change

We want to ensure our customers' loved ones have support in a difficult time. Now for customers who have health insurance for more than 13 months and pass away due to deliberate self-harm, their family members can access this extra financial help.

This change applies to the below products and will apply to claims that have been submitted from the 5th September 2017 onwards:

  • Private Health
  • Absolute Health
  • MajorCare


These changes don't apply to staff MajorCare, EBS and Sure Health products. For full details on the above, please refer to the policy wording.


Health Enhancements - 10th November 2017

Our latest updates reflect the trends we've seen across technology, our claim stories, and also our desire to give our customers on older products access to some of the great benefits Private Health has.

These benefits apply to the below products and w​ill apply to claims that have been submitted from the 5th September 2017 onwards:

  • Private Health
  • Absolute Health
  • MajorCare

These benefits DON'T apply to staff MajorCare, EBS and Sure Health products.

1. Extending the Post Cancer Treatment Care and Support Benefit to legacy health products

Find out more

The background

Currently this benefit gives all Private Health customers access to support services and personal items post-cancer diagnosis, such as lymphatic massage and counselling. Up to $1,000 per policy year can be claimed and no excess applies.

The Change

We care about supporting all our customers back to full health and wellbeing following cancer diagnosis. So we've now made this benefit available to all our customers with Absolute Health and MajorCare policies as well as Private Health.

2. Providing coverage for Temporomandibular Joint (TMJ) surgery for legacy health products

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The background

All our Private Health customers are covered for TMJ (hinge connecting the jaw to the temporal bones of the skull) surgery under the surgery benefit.

The Change

Surgery for TMJ can be a major medical expense so we now cover TMJ surgical procedures under all MajorCare and Absolute Health policies as well as Private Health.

3. Inclusion of skin prick test and skin biopsies under the Minor Surgery benefit

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The background

Coverage for skin prick testing and skin biopsies is currently available under our Specialist Consultations benefit. However, customers can get these done easily from a General Practitioner (GP). This provides a smoother treatment path for customers instead of having their care split between two doctors.

The Change

Customers with any Sovereign health insurance product can now see a GP to have a skin prick test and/or skin biopsy performed.

4. Cover the cost of pacemakers and Implantable Loop Recorders (ILR)

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The background

We always look for ways to further help our customers as medical technology and devices evolve.

For our customers who required a pacemaker operation, we covered the surgery cost but not the pacemaker device itself.

Under our Diagnostic Imaging and Tests benefit we cover the cost of electrocardiographic (ECG) tests. However for customers with recurrent irregular heart rhythms, this could require multiple ECGs to detect. Implantable Loop Recorders (ILR) record ECG data automatically instead of having to see a specialist multiple times, but these would be at the expense of the customer.

The Change

Customers with Sovereign health insurance can now claim for pacemakers and Implantable Loop Recorders.

For those who undergo a pacemaker operation, we'll also cover the cost of the pacemaker device. They can focus on recovery rather than financial costs post-surgery.

Customers who experience recurrent irregular heart rhythm issues can now access ILRs at no cost and have an accurate record of ongoing symptoms to build the right treatment plan sooner.

For full details on all of the above, please refer to the policy wording.


Health Enhancements - 5th Decembe​r 2016

These benefits apply to:

  1. All new policies commencing from 5th December 2016
  2. Existing Private Health Cover and Private Health Plus
  3. Absolute Health
  4. MajorCare sold after 2003

 

Summary of Enhancements:

​Surgical benefit is now unlimited
The $300,000 annual limit on the amount you can claim has now been removed. There is no limit on the cover under this benefit.

Find out more

New Private Health 2016 Policy Wording*

Surgery unlimited per life assured.

Covers the costs associated with surgery, subject to reasonable charges. Surgery must be performed in an approved facility by a registered medical specialist or an oral surgeon. The excess applies to any claims under this benefit.

Cover is provided for the following costs:

Inpatient Care
  • Surgeon’s fees/ Oral surgeon’s fees / Cardiologist’s fees/ Anaesthetist’s fees/ Perfusionist’s fees/ Radiologist’s fees
  • Hospital fees including Accommodation / Operating theatre fees/ Intensive/coronary care unit fees/ Ancillary hospital charges / Disposable laparoscopic equipment/ Prostheses
Outpatient treatment
  • Consultations with a registered medical specialist or oral surgeon (including second opinions) and diagnostic imaging and tests referred by a registered medical specialist or oral surgeon directly relating to the approved surgery, performed within six months before or after surgery.
  • Physiotherapy and prescription costs directly relating to the approved surgery provided within six months after surgery on the recommendation of a registered medical specialist or oral surgeon.

Please note: For MajorCare 2003, the time limits for the above benefits are three months before or after surgery for consultations, and three months after surgery for physiotherapy and prescription costs.

Outpatient treatment costs now included
Within six months after surgery (or three months for MajorCare 2003) you can claim for physiotherapy and prescription costs directly relating to the approved surgery. This is now included under the unlimited surgical benefit.

Find out more

New Private Health 2016 Policy Wording*

Surgery unlimited per life assured.

Covers the costs associated with surgery, subject to reasonable charges. Surgery must be performed in an approved facility by a registered medical specialist or an oral surgeon. The excess applies to any claims under this benefit.

Cover is provided for the following costs:

Inpatient Care
  • Surgeon’s fees/ Oral surgeon’s fees / Cardiologist’s fees/ Anaesthetist’s fees/ Perfusionist’s fees/ Radiologist’s fees
  • Hospital fees including Accommodation / Operating theatre fees/ Intensive/coronary care unit fees/ Ancillary hospital charges / Disposable laparoscopic equipment/ Prostheses
Outpatient treatment
  • Consultations with a registered medical specialist or oral surgeon (including second opinions) and diagnostic imaging and tests referred by a registered medical specialist or oral surgeon directly relating to the approved surgery, performed within six months before or after surgery.
  • Physiotherapy and prescription costs directly relating to the approved surgery provided within six months after surgery on the recommendation of a registered medical specialist or oral surgeon.

Please note: For MajorCare 2003, the time limits for the above benefits are three months before or after surgery for consultations, and three months after surgery for physiotherapy and prescription costs.

Cancer care cover extended
You can now access $5k to cover breast symmetry surgery following a mastectomy covered by your Sovereign  Health Policy.

Find out more

New Private Health 2016 Policy Wording*

Covers costs up to the maximum cover for procedures to achieve breast symmetry in the breast unaffected by cancer. This will be available either during or following a mastectomy, which has been covered by your Sovereign Private Health policy. No excess is payable for any claims under this benefit. Prior approval must be obtained before the procedure takes place.

Dental support before major treatments
Get dental assistance before certain chemotherapy and radiotherapy treatments and heart valve replacement surgery covered by your Sovereign Health Policy where recommended prior to these treatments and procedures.

Find out more

New Private Health 2016 Policy Wording*

$1,500 per life assured per policy year

Covers dental evaluation and treatment performed by an oral surgeon or a dental practitioner, on the recommendation of the treating registered medical specialist as a precursor to the following treatments:

  • chemotherapy using antiresorptive drugs
  • radiotherapy treatment (head and neck)
  • heart valve replacement surgery

Clarified Non-Pharmac chemotherapy
We’ve introduced non-Pharmac, med-safe cancer treatment drugs for customers on our closed product Absolute Health and MajorCare 2003.

Find out more

New Private Health 2016 Policy Wording

Chemotherapy treatment including targeted therapy, immunotherapy medicines, oral, intravenous infusion, instilled, and intraoperative chemotherapy provided by or under the direction of a registered medical specialist in an approved facility.

This covers the cost of Pharmac and non-Pharmac subsidised MedSafe indicated cancer chemotherapy drugs, subject to Sovereign criteria.

Get treated anywhere in the world
You can now go beyond  Australia to choose to have treatment. For approved treatments outside Australia, up to 75% of the reasonable costs (subject to applicable maximums) may be covered.

Find out more

New Private Health 2016 Policy Wording*

This covers the costs associated with medically necessary consultations, diagnostic imaging and tests or treatment covered by one of the other benefits of this policy is carried out overseas at a health service facility approved by Sovereign.

Treatment in Australia

This benefit covers the reasonable charges of the approved treatment or procedure up to 100% of the reasonable charges payable in New Zealand equal to the maximum cover under this policy stated for the applicable benefit in New Zealand dollars.

Treatment beyond Australia

This benefit covers the reasonable charges of the approved treatment or procedure up to 75% of the reasonable charges payable in New Zealand equal to the maximum cover under this policy stated for the applicable benefit in New Zealand dollars.

To be eligible for the voluntary overseas treatment cover beyond Australia;

  • the procedure or treatment has been recommended by a New Zealand registered medical specialist; and
  • is carried out by an overseas health service provider approved by Sovereign
  • following the treatment or procedure, a completed claim form and receipt in English needs to be provided to Sovereign.

Increased minor surgery cover
The claim amount has been increased to $1,000 a year.

Find out more

New Private Health 2016 Policy Wording*

$500 per procedure & $1,000 per policy year

Covers the cost up to the maximum cover for this benefit of the following minor surgeries and procedures:

  • Excision of lesions, moles, cysts and ingrown toenails
  • Allergy desensitisation injections, varicose vein treatment and vasectomy
  • Cover for vasectomy is only available after one year of continuous cover.

The minor surgery or treatment must be carried out by a General Practitioner or under the care of a General Practitioner at an approved facility.

No excess is payable for any claims under this benefit.

Increased the home nursing benefit
This has been increased to $5,000 a year. This only applies to Private Health and MajorCare 2003 as it already applies to Absolute Health.

Find out more

New Private Health 2016 Policy Wording*

$300 per day, up to $5,000 per life assured per policy year

 

Think you need to make a claim?

You can lodge a claim online, or call us on 0800 500 108 (8am-6pm Monday to Friday). Alternatively contact your Adviser.

 

*Other products may use slightly different wordings and definitions.​​​​​​​​​​​​​​​​

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