Benefits Covered Expenses Maximum Cover Surgery

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1 Schedule of Benefits February 2013 You are eligible to be covered by SmartStay and Smartstay Plus Plan if you are in New Zealand and you have a work permit. Your family can also be covered - all they need is a New Zealand visitor s permit. Schedule of Benefits With SmartStay, our comprehensive base plan, you re covered for just about every cost associated with hospital and surgical care, even oral surgery. You have a choice of excess - from $0 to $ and the greater the excess the lower the premium. The excess applies once per life assured per policy year. And remember, there s no stand-down period for SmartStay so you are covered from day one (subject to our risk assessment). Benefits Covered Expenses Maximum Cover Surgery General Surgery Covers the costs of reasonable and customary charges associated with the pre-approved procedure(s) and all subsequent eligible treatment or expenses, including: Private or public hospital costs. Physiotherapy while in hospital. Surgeons fees. Anaesthetists fees. Costs of essential prosthesis within Accuro Health Insurance schedule. Pre-operative and post-operative diagnostics, consultations or tests provided they occur within six months prior to or after the approved surgery. All costs must be associated with the original diagnosis, including complications of the initial surgery. Note: Oncology consultations and treatment following surgery is covered under the medical hopitalisation section of the policy. $150,000 per claim. Oral Surgery Provider must be a New Zealand Registered Oral or Maxillofacial Specialist, or an accredited private/public hospital or clinic. Member or Participant must be referred by a New Zealand Registered Medical Practitioner, Dental Surgeon or Dentist. Covers the cost of reasonable and customary charges associated with: Surgical removal of impacted or unerupted teeth only, provided a participant has been covered by the policy for at least 12 months. Surgical removal of cysts, soft tissue swellings and other medical (not dental) conditions of the mouth that require major surgical intervention. Surgical drainage of oral abscesses. Pre-operative and post-operative diagnostics, consultations or tests provided they occur within six months prior to or after the approved surgery.

2 Benefits Covered Expenses Maximum Cover Medical Hospitalisation Private or Public Hospital Medical admission Covers the cost of reasonable and customary charges associated with: Admission to a private or public hospital for reasons other than surgery. For example (without limitation) non surgical cancer treatment, respiratory disease (such as asthma and pneumonia) and endocrine disease (such as diabetes). Diagnostics, consultations or tests provided they relate to the condition being treated and that they occur within six months prior to or after admission to a private or public hospital. Admissions do not cover, and are not restricted to convalescence, recovery, respite care, obstetrics, mental health, geriatric, senile or recurrent health conditions. To qualify for non surgical cancer treatment benefit the treatment required would have to be classified as either: A (Urgent), or B (Curative) using Ministry of Health guidelines. To a maximum aggregated cover of $65,000 per person per policy year. Non surgical cancer treatment is limited to a maximum of $25,000 per course of treatment, up to a maximum aggregated cover of $65,000 per policy year. Diagnostic Procedures Major Diagnostic Procedures With or without hospitalisation Covers the costs of reasonable and customary charges associated with the following diagnostic procedures: Angiogram. MRI. CT Scan. Myocardial perfusion scan (MP scan). Per person per policy year: Angiogram $3500 MRI Scan $3000 CT Scan $2500 MP Scan $2000 Minor Surgery Minor Surgery Performed by a New Zealand Registered Medical Practitioner in private practice Covers reasonable and customary charges for minor surgery including removal of moles, cysts and toenails. Procedure(s) must be medically necessary and without it, the member s or participant s physical wellbeing would be affected. $500 per claim.

3 Benefits Covered Expenses Maximum Cover Other Benefits Treatment Outside New Zealand Covers the costs of reasonable and customary charges for medically necessary and recognised surgical procedure(s) at an overseas hospital. To qualify for this benefit: The Member or Participant must be in New Zealand at the time of diagnosis. The Member or Participant must have partaken in an appropriate medical process in New Zealand. The surgical procedure requested must not be available in New Zealand nor be experimental or being trialled, and it must meet all policy criteria. The Member or Participant must provide written confirmation from a New Zealand Registered Specialist that the surgical procedure is necessary and not available in any variance in New Zealand. Travel and accommodation for overseas surgical procedure(s) is not covered by Accuro Health Insurance. $25,000 per person per policy year. Speech and Language Therapy Covers the costs of post operative treatment for approved surgery under this policy. Treatment must be completed within six months of approved surgery and performed by a New Zealand Registered Speech and Language Therapist who is a member of the New Zealand Speech Language Therapists Association. $80 per visit. $400 per person per policy year. Physiotherapy Covers the costs of post operative physiotherapy for approved surgery under this policy by a New Zealand Registered Physiotherapist with a current practising certificate who is in private practice. To be eligible for post operative physiotherapy, the treatment must commence within 14 days after related surgery approved under this policy. $60 per visit. $300 per hospitalisation. Home Nursing Covers the costs of home nursing care by a New Zealand Registered Nurse. Care must be provided as a result of a referral by a New Zealand Registered Medical Practitioner. Post operative nursing care must commence within 14 days after related surgery has been approved under this policy. $150 per day. $2400 per person per policy year. Ambulance Transfer Covers the costs of ambulance transfers to or from a public or private hospital within New Zealand. Transfer must be authorised by a Registered Specialist. Benefit is available to private fee-paying patient(s) whose initial admission to hospital was pre-approved by Accuro Health Insurance. Benefit is available for necessary treatments and not for personal or social reasons. $200 per person per policy year.

4 Benefits Covered Expenses Maximum Cover Air Transport and Accommodation Benefit Covers the costs of air transport if the Registered Specialist confirms in writing that the condition cannot be treated at a local private or public facility and the member or participant needs to travel by air for alternative private or public hospitalisation within New Zealand. These costs must directly relate to the hospitalisation. Pre operative and post operative consulatations/treatments do not qualify. Pays the following for the patient and one support person: Return airfare. Taxi fare from airport to hospital and return. Support person accommodation allowance. Claim must be accompanied by receipts for reimbursement. $125 per night, up to $1500 per person per policy year. Economy airfare only. Economy taxi fare only. Parent Accommodation Benefit Covers the costs of accommodation expenses actually incurred by a parent accompanying a child aged under 18 years who is listed on the membership certificate. Child must be undergoing medical treatment approved by Accuro Health Insurance in an approved private or public hospital in New Zealand. Benefit is available for one adult only. Claim must be accompanied by receipts for reimbursement. $125 per night, up to $1500 per person per policy year. Free Cover for First Child Cover is operative from date of birth for four months. Child must be added to the policy at the time of birth and continue to be covered for a minimum of 24 months. Appropriate certificate and documentation must be provided. Pre existing conditions are not automatically covered. ACC Top-up Benefit Where ACC have declined or partially accepted a claim for private hospital expenses, Accuro Health Insurance will cover either full or partial payment of the claim. A copy of the appropriate acceptance/declinature documentation must be forwarded to Accuro Health Insurance before the claim will be accepted. The Member/Participant may be required to apply for a review or even appeal of a declined claim by ACC. The Member/Participant must reimburse Accuro Health Insurance for any cost subsequently recovered from ACC as a result. Conditions apply (Please refer to our General Terms and Conditions for full description). Dependants Cover Unique to Accuro Health Insurance, dependants are covered on the parents plan up to the age of 25 years. Child premium rate is applicable for dependants up to age 25 years. To qualify, dependants must be covered by parent s/guardian s policy.

5 SmartStay Plus Schedule of Benefits With SmartStay Plus you re covered for up to $4000 a year for the costs of visiting a Registered Specialist as well as diagnostic tests referred by Registered Medical Practitioners or Registered Specialists. applies to benefits covered under SmartStay, and you are covered from day one (subject to our risk assessment). If consultation, diagnostics and/or tests result in admission to a private or public hospital, and they occur within the sixmonth period prior to or after the admission, these will be covered under SmartStay plan. For a specialist consultation you must be referred by a New Zealand Registered Medical Practitioner. Registered Specialist must be a health provider who is a Member or Fellow of an appropriately recognised specialist college and must have Medical Council of New Zealand vocational registration and current annual practicing certificate in that specialty. Cover is not available for routine screening/surveillance or periodic testing unless specifically medically necessary. Benefits Covered Expenses Maximum Cover Specialist Consultations Covers the cost of reasonable and customary charges of Registered Specialist consultations when referred by a Registered Medical Practitioner. Specialist consultations include (but not limited to): Cardiac surgeons. Cardiologists. General surgeons. Neurosurgeons. Paediatricians. Urologists. Ophthalmologists. Gynaecologists. Oncologists. Gastroenterologists. Orthopaedic surgeons. Ear, nose and throat specialists. Cover is not applicable to psychologists, psychiatrists and obstetricians unless specifically provided for. Aggregated maximum of $4000 per person per policy year. Diagnostic Tests Covers the costs of reasonable and customary charges of diagnostic procedures directly relating to a medical condition when referred by a Registered Specialist. Covers the following tests: Bone density scan. Allergy testing. Audiology. Audiometric tests. Electroencephalography (EEG). Exercise ECG. Electromyography (EMG). Nerve conduction test. Laboratory tests. Holter monitoring. Ambulatory blood pressure monitoring. Ultrasound. Mammography. Stress echocardiogram. X-rays. Dobutamine and transoesphageal echocardiography.

6 Benefits Covered Expenses Maximum Cover Diagnostic Tests continued from previous page... Covers the costs of reasonable and customary charges of diagnostic procedures directly relating to a medical condition when referred by a Registered Specialist. Cardiovascular ultrasound. Urodynamic assessments. The following tests are covered to a maximum of $1500 per event. Nuclear scanning. Cardioversion. Endoscopies. (continued from previous page...)

7 General Information Acceptance into the SmartStay Plan entitles a Participant to full cover as described in this schedule, less the specified excess, and in accordance with any special conditions stated in the membership certificate issued at the time of acceptance. Membership commences from the date on which the first subscription is received by Accuro Health Insurance. On receipt of the confirmation of membership from Accuro Health Insurance the Member has a free-look period of 14 days in which the Plan may be declined. Any subscriptions paid will be refunded if the Plan is declined within the free-look period, provided that during this period no claim has been made in respect of any person covered by this application. All benefits described in this Schedule of Benefits are subject to the provisions described in the General Terms and Conditions of Accuro Health Insurance as amended from time to time and should be read in conjunction with your membership certificate. Accuro Health Insurance Accuro Health Insurance is the trading name for the Health Service Welfare Society Limited, which is incorporated under the Industrial and Provident Societies Act Like all societies, it has Rules which will bind you. The Rules govern the way the Society is run and the health benefit plans it administers. The Rules are subject to change. If you want a copy of the current Rules before making your application, please feel free to ask us for a copy. Accident, Treatment Injuries or Employment Related Conditions Accidental injury can happen at any time. In New Zealand the Accident Compensation Corporation (ACC) covers accidents, treatment injuries and employment-related injuries, amongst other situations. Prior to any treatment costs being incurred ACC must have first been approached and a copy of their letter of acceptance in full or part, or declination provided to the Society. In instances where ACC has declined a claim for injury, Accuro Health Insurance will at its sole discretion either assist with full or part payment, or require the Participant to apply for a review and if necessary an appeal of the decision. General Exclusions Some situations are not covered (unless specifically provided for in the Accuro Health Insurance Schedule of Benefits). For example (without limitations): general practitioners fees; drugs and medication; cosmetic procedures and/or other enhancement/appearance medicine; medical mishap; palliative care; contraception of any kind, pregnancy, childbirth or adoption; dental care; orthodontic; endodontic; orthognathic and periodontal treatment; psychiatric and/or psychological treatment or counselling; disability or illness arising from the misuse of alcohol or drugs; preventative healthcare treatments and services; AIDS or HIV infection; any expense recoverable from a third party under any contract of indemnity or insurance; breast reduction; chelation therapy; long term care; surgery or laser treatment for the correction of visual errors and astigmatism; personal health related appliances; chronic conditions, any medical cost incurred outside New Zealand; any cost not specifically provided for under a benefit section contained in the plan selected. Exclusions are subject to change. For a full list of exclusions please see Accuro Health Insurance General Terms and Conditions. Prior-Approval Procedures Prior-approval is required for any expense over $1000 or where the treatment involves any hospitilisation, day stay or in patient stay regardless of the cost. Failure to do so will prejudice the ability to claim for the treatment costs at a later date. A minimum of five working days' notice is required to give Accuro Health Insurance time to do any necessary checks and send out confirmation before the procedure takes place. However, to ensure that the medical treatment or procedure is covered under the Schedule of Benefits of the Member's Plan it is recommended you contact us as soon as possible to check eligibility. Accuro Health Insurance will pay your accounts directly to the provider. All claims and prior-approvals are based on reasonable and customary costs for the services provided. Pre-Existing Health Conditions Only pre-existing health conditions that have been declared on the application to join and accepted by Accuro Health Insurance will be covered. Reciprocal Health Agreements Australian citizens and permanent residents and citizens of the United Kingdom living in the UK who visit New Zealand on a temporary basis (less than two years) can receive urgent medical treatment in New Zealand if they are eligible under one of the Reciprocal Health Agreements between New Zealand and Australia or UK. These reciprocal agreements provide access to hospital services, pharmaceuticals or maternity services that are urgently needed. These services are the same services that New Zealanders receive. For more details about the types of treatment available and the eligibility criteria please visit the New Zealand Ministry of Health website The SmartStay policy does not cover you for medical treatment for which you are eligible under a Reciprocal Health Agreement. Prescription Drugs Prescription drugs must be listed on the PHARMAC schedule and the Member must be eligible to meet PHARMAC's funding criteria. Issue Age Issue age years. Individual consideration will be given to ages outside this range. Issue age is not applicable to dependants.

8 Level 1 79 Boulcott Street PO Box Wellington 6143 New Zealand Freephone 0800 ACCURO ( ) info@accuro.co.nz Facsimile Accuro Health Insurance is the trading name of the Health Service Welfare Society Limited, which is incorporated under the Industrial and Provident Societies Act ACC /13