Effective 1 August 2013

Transcription

1 UNION MEDICAL BENEFITS SOCIETY LTD CONDITIONS OF MEMBERSHIP Effecte 1 August APPLICATION FORM To make an applcaton for coerage, applcants must complete a current UnMed health nsurance applcaton form contanng the health declaraton. UnMed may refuse to accept any applcaton wthout gng any reason for such refusal. Each member, partner or dependant must be a resdent of New Zealand. 2 INTERPRETATIONS/DEFINITIONS These relate to the Condtons of Membershp, Membershp Certfcate and the Beneft Schedule (your polcy). Please refer to the Glossary of Interpretatons/Defntons as contaned on pages 7 to 8 at the rear of ths document. 3 MEMBERSHIP COMMENCEMENT DATE Ths s the date the applcaton for membershp was accepted by UnMed and s shown on your Membershp Certfcate. Ths date s ordnarly the annersary of the commencement date of the polcy howeer n selected group nsurance arrangements the annersary date wll be the annersary date of the commencement of the group s nsurance arrangements wth UnMed. 4 COVER START DATE Ths s the date from whch clams are payable by UnMed and s shown on your Membershp Certfcate. No clam can be accepted for the rembursement of condtons arsng or treatment costs ncurred pror to the coer start date of your polcy. 5 NO CLAIM PERIOD (STAND DOWN PERIOD) Coer starts three months after the membershp commencement date unless otherwse agreed to by UnMed n wrtng and confrmed on your Membershp Certfcate. A No Clam Perod of three months wll also apply to any other person who may at a later date be added to your polcy unless otherwse agreed to by UnMed n wrtng. PAGE 1

2 6 PRE-EXISTING CONDITIONS A pre-exstng condton s one that was n exstence on or before the person s coer start date. At that tme the person:- (a) (b) (c) May hae known of the condton, or May not hae known of the condton, but dd know of a health hstory or symptoms whch could hae ndcated the possble exstence of the condton to a medcal practtoner, or May not hae known of ether. The outcome of any clam wll depend on whch of the three categores apples. If category 6 (a) apples:- (a) (b) A falure to hae declared the condton wll mean there s no coer for that condton and, further, perhaps no coer under the polcy at all. To hae declared the condton wll mean there s ntally no coer for that condton, but, after there has been three years contnuous membershp, UnMed may extend the coer to encompass t. Any araton/ excepton wll be detaled n the Membershp Certfcate. If category 6 (b) apples:- (a) (b) A falure to hae dsclosed the hstory or symptoms wll mean there s no coer for that condton and, further, perhaps no coer under the polcy at all. To hae dsclosed the hstory or symptoms wll hae put the onus on UnMed to determne the extent of the coer to be offered n the crcumstances. Unless UnMed excludes the condton n the Membershp Certfcate, t wll be coered een though pre-exstng (proded t s otherwse wthn the polcy). If UnMed excludes the condton, after three years the poston wll be the same as outlned n 6 (b) aboe. If category 6 (c) apples, there wll be coer for that condton, rrespecte of t beng a pre-exstng condton (proded t s otherwse wthn the polcy). 7 DUTY OF DISCLOSURE It s, therefore, extremely mportant to hae gen careful thought to one s health hstory and current physcal wellbeng, (and that of all other persons coered by the polcy) and to hae let UnMed know of anythng whch mght later be seen to hae dered from or to hae ndcated the presence of a condton whch was n exstence at the tme you sought nsurance een though you dd not know t. If n doubt as to whether somethng s releant as hstory or s a symptom of anythng, you should dsclose t and leae UnMed to determne the sgnfcance of what you hae dsclosed. If on reflecton you realse there was further nformaton you should hae gen at the tme of applyng for coer you may remedy that by supplyng the further nformaton wthn 7 days of the date of recept of the Membershp Certfcate, n whch eent your applcaton wll be reprocessed wthout the earler omsson beng held aganst you. If you or any other person detaled on the Membershp Certfcate fal to dsclose any materal nformaton UnMed may cancel the polcy from the commencement date and not pay any clams. UnMed may retan all premums pad and any clams pad may be recoered from the member. 8 LOYALTY BENEFITS Loyalty Benefts are proded for members to recognse ther length of contnuous membershp n the same plan. Each specfc beneft n the Loyalty Benefts secton of the arous plans specfes a qualfyng tme (that s the length of contnuous membershp n the same plan) whch s requred pror to the lsted beneft commencng. Loyalty Benefts apply to all qualfyng pre-exstng condtons (standard Loyalty Beneft exceptons beng, cardoascular/ascular surgery, jont replacement surgery, pre-cancer/cancer, and accdent condtons) unless excluded elsewhere n the Condtons of Membershp. 9 NOT INCLUDED IN COVER No clam wll be accepted for, or n assocaton wth, the followng condtons unless specfcally proded for n UnMed s arous plans:- Accommodaton costs for non-patents whlst accompanyng patents n hosptal. PAGE 2

3 Acupuncture treatment other than that performed by a Regstered Medcal Practtoner. AIDS or HIV nfecton or any condton arsng from the presence of AIDS or HIV nfecton. Any costs not specfcally proded for under a beneft secton contaned n the plan selected. Any expense recoerable from a thrd party under any contract of ndemnty or nsurance or any statutory scheme. Any health condton not regstered wth the Mnstry of Health as a dsease entty. Any medcal costs ncurred outsde New Zealand. Any unapproed medcal serce. Surgcal or medcal applances ncludng dabetc montorng equpment and/or lost applances. Breast reducton procedures performed for any reason. Chelaton therapy or smlar treatment as defned by UnMed. Chronc condtons. Cochlear mplants. Congental/deelopmental condton(s). Contracepton of any knd. Cosmetc treatment. Pre-senle dementa. Dental care ncludng Oral Surgery ncludng condtons arsng out of the neglect of dental serces. Alments solely or partally attrbutable to the use of non-prescrpton drug(s). Dsablty or llness arsng from msuse of alcohol or drugs. Gender reassgnment. Gynaecomasta. Health surellance testng. Treatment of nfertlty ncludng dagnostc testng. Self nflcted njures or llness. Injury or dsablty suffered as a result of terrorsm, war or any act of war declared or undeclared or of acte duty n the mltary, naal, or ar forces of any country or nternatonal authorty. Mole Mappng. Treatment for obesty ncludng medcal/surgcal treatment ndrectly attrbuted to obesty. Organ donaton or recept. Orthodontc and perodontal treatment ncludng surgery desgned to assst or allow the mplementaton of orthodontc healthcare serces. All condtons of, or as a consequence of, and/or assocated wth pregnancy and chldbrth. Preentate medcne and accnatons. Psychatrc and/or psychologcal treatment or counsellng ncludng Attenton Defct Dsorder (A.D.D & A.D.H.D). Renal dalyss, blood products, Contnuous Ambulatory Pertoneal Dalyss (CAPD), and specalsed transfusons of blood. Senle condtons wth dependency ncludng geratrc hosptalsaton. Sexually transmtted dseases. Refracte surgery for the correcton of short sght or long sght ncludng Astgmatsm. Any nestgaton and/or treatment for sleep dsturbance, snorng, or obstructe sleep apnoea. Sterlsaton or reersal. Teleson, telephone and/or any personal ncdental expenses ncurred whlst n hosptal. Trael costs. Treatment for a condton whch n the opnon of UnMed s Medcal Referee s not detrmental to health. Treatment whch n the opnon of UnMed s Medcal Referee s not medcally necessary ncludng but not lmted to practces whch are expermental, unorthodox and not wdely accepted as effecte, approprate or essental accordng to the recognsed standards of the medcal specalty noled. 10 ACUTE SECONDARY CARE No clam wll be accepted under any beneft secton for Secondary Care relatng to Acute medcal and surgcal serces other than as specfcally proded for under the Acute Prate Hosptalsaton Medcal/Surgcal Grant as contaned n the arous plans. 11 INJURY OR EMPLOYMENT RELATED CONDITIONS No clam can be accepted for any treatment whatsoeer, whether n full or part, requred as the result of personal njury by accdent or employment related condtons whch frst occurred: EITHER pror to the coer start date. OR pror to 1 May 1990 f the coer start date preceded ths date. No clam can be accepted for any Secondary Care for workplace/employment related condtons occurrng on or after 1 July 1999, rrespecte as to whether those condtons were accepted n full or part or declned by the Accdent Insurer as defned under the Accdent Insurance Act PAGE 3

4 Unless wrtten edence from ACC declnng payment approal (ncludng the reasons for declnaton) s proded to UnMed pror to the treatment beng undertaken, no beneft shall be pad n respect of any treatment requred due to or arsng as a result of personal njury by accdent or employment related condton. If the ACC refuses or ceases coer under Secton 117 of the Injury Preenton, Rehabltaton and Compensaton Act 2001 (or any amendment thereto) due to your falure to comply wth the ACC requrements, you wll be deemed by UnMed to not hae made a reasonable effort to secure coer and therefore be nelgble to clam on your UnMed polcy. In nstances where ACC has declned a clam for njury (other than for workplace/employment related condtons), UnMed wll at ts sole dscreton ether assst wth the total cost of the treatment/surgery to the lmts of the member s chosen plan, or pay the dfference between the actual costs of treatment to the lmts of benefts applcable to your chosen plan less what ACC would hae pad had they accepted the clam. If ACC declnes coer for treatment n full or n part, UnMed reseres the rght to apply to the ACC for a reew or appeal of that decson on the member s behalf. Pre-exstng njures/employment related condtons do not qualfy for Loyalty Benefts as contaned n some plans. 12 SUBSCRIPTIONS Membershp of UnMed s on an annual bass and subscrptons to ts plans are payable n adance; UnMed may by arrangement accept payment of the annual subscrpton at other frequences as agreed to by UnMed. The mantenance of membershp s condtonal upon the contnual payment of all subscrptons as they fall due. Clam payments may be wthheld by UnMed n the eent that there are arrears of subscrptons pendng the arrangement of a mutually acceptable bass for the payment to UnMed for any such arrears. Responsblty for ensurng that subscrptons are kept current rests solely wth the member and membershp wll be termnated n the eent that the member fals to pay any subscrptons wthn three months of the due date. As a means of settlng arrears, UnMed, at ts absolute dscreton, reseres the rght to deduct from clam proceeds any amount whch may be outstandng at the tme of the clam beng payable. UnMed can alter the schedule of premum rates (ncludng the ages at whch the premum automatcally ncreases), or the benefts proded under any health plan, at any tme by gng you 30 days pror wrtten notce of the changes to your last known address. 13 TERMINATION OF MEMBERSHIP The member may termnate membershp at any tme upon gng one month s notce n wrtng to UnMed. UnMed may cancel membershp n terms of the rules of UnMed. Any subscrptons pad n adance wll be refunded to the member from the date of cancellaton prodng a clam has not been lodged for the nsurance year from whch the refund wll be calculated. Followng the termnaton of a polcy, coer s unable to be renstated. Indduals may at a subsequent tme apply to UnMed for a polcy by completng a new health nsurance applcaton form. 14 CLAIMS PROCEDURE (a) General Clams can only be accepted for costs whch hae been ncurred for qualfyng consultatons/treatment occurrng after the coer start date and before the termnaton date of the polcy. For any treatment or surgery to qualfy for rembursement t must be consdered by UnMed to be medcally necessary. All clams must be lodged wthn 15 months of the date of consultaton. The total amount clamed should always exceed $50.00 unless a clam has not been lodged wthn the preous 12 months. The clams handlng fee wll apply to the thrd and subsequent clams lodged n each nsurance year. PAGE 4

5 (b) Clams must be submtted on the prescrbed clams form. Any clams for benefts may need to be supported by such approprate edence as UnMed may requre. You must ge a descrpton of the reason for treatment, the nestgaton/treatment undertaken, the date of treatment and all medcaton requred on the clams form. You must state f treatment was accdent related. The clams form must be accompaned by orgnal recepted temsed accounts showng the name of the Regstered Health Serce Proder and the patent concerned. Photocoped, EFTPOS or credt card recepts wll not qualfy for rembursement. Prate Hosptal Surgcal Admssons Unless specfcally proded for n UnMed s arous plans:- Upon becomng aware that any person named on your polcy may requre to make a clam under the surgcal secton of your nomnated health nsurance plan, you must mmedately notfy UnMed s Customer Serces secton (tollfree ) of all releant detals. Falure to prode notfcaton at the earlest opportunty may prejudce your ablty to clam for the proposed surgery. Payment s lmted to the lesser of the beneft leels of your chosen plan or the usual and customary charges for any approed procedure at the tme of serce. Ths means UnMed may negotate wth your nomnated serce proder(s) or recommend alternate serce proder(s) f the estmated cost receed from your chosen proder(s) s aboe usual and customary leels. You may then ether retan your orgnal serce proder(s) and pay the dfference n costs aboe those deemed to be usual and customary or alternately transfer your surgery to the proder(s) wllng to prode the serce wthn usual and customary cost gudelnes. UnMed has the rght to declne a clam for treatment n a Prate Hosptal where t s establshed that treatment was aalable n a Publc Hosptal wthn a reasonable tmeframe. 15 HEALTHCARE PROVIDERS AND SERVICES QUALIFYING FOR REIMBURSEMENT x x Under the Prescrptons Beneft, only those drugs lsted on the Pharmac Schedule and prescrbed by a Regstered Medcal Practtoner wll be accepted for a refund up to the stated lmts. Vson Care (as proded for n some plans). For a clam to be accepted under these sectons, a change n exstng lenses must be prescrbed or prescrpton lenses be prescrbed for the frst tme. Replacement due to loss/damage or wthout a prescrbed change n prescrpton s not proded for. Oral Surgery Beneft. For a clam to qualfy under ths beneft, surgery must be performed by an oral and maxllofacal surgeon regstered wth the Dental Councl of New Zealand. Ths beneft secton excludes coer for the extracton/surgcal remoal or mplantaton of teeth or for normal dental treatment. Audology. For costs to qualfy under ths beneft, treatment must be by a qualfed Otologst or Audologst. Consultant Physcan. For a clam to be pad under ths beneft secton treatment must be performed by a Qualfed and Regstered Consultant Physcan. Ths beneft s only payable where a specfc referral from your GP or Specalst has taken place. New Zealand Regstraton. Any health professonal concerned must, where such s requred, hold current regstraton n New Zealand. For any treatment to qualfy t must be proded by a Regstered Medcal Practtoner and/or a Regstered Physotherapst, Regstered Nurse Practtoner, Chropodst, Podatrst, Chropractor, Osteopath (wth New Zealand Regstraton), Oral Surgeon or Optcan for a clam to be ald. Hosptal admssons must be under the care of a Regstered Medcal Specalst or Oral Surgeon. Unless otherwse specfed Prate Hosptalsaton Surgcal Benefts are proded for Non Acute Qualfyng Surgcal Procedures together wth that procedure s assocated recoery and performed by a Regstered Medcal Specalst n a Lcensed Prate Surgcal Hosptal. Specfc Benefts. In nstances where a beneft brochure prodes a specfc beneft for treatment or serces (e.g. Angogram, Angoplasty) then the total amount clamable under the polcy s lmted to the specfc benefts as proded. Lthotrpsy treatment s accepted n qualfyng cases to maxmum lmts as set down by UnMed n ts arous Plan Schedules. Should a clam be settled under ths beneft, the member forfets any further rghts or enttlements under the Lthotrpsy Beneft or under any other Hosptal Schedule Beneft for a perod of fe (5) years n connecton wth the same or smlar medcal condton. PAGE 5

6 x x Sclerotherapy or endoenous laser ablaton. Treatment performed by a Regstered Medcal Practtoner wll be accepted for coer under the Prate Hosptalsaton Surgcal secton PROVIDED that pror to surgery takng place, a wrtten report s receed from a Specalst Vascular Surgeon adsng that the treatment s a able alternate treatment to surgcal nterenton for a ascular condton whch n the opnon of the Specalst Vascular Surgeon s at a stage of requrng surgcal nterenton. In all other nstances sclerotherapy or endoenous laser ablaton s excluded from coer. Any treatment costs ncurred at a Publc faclty whch s ether drectly or ndrectly controlled by a Dstrct Health Board or any future controllng authorty are excluded from coer. 16 GENERAL x All members are bound by and therefore subject to the rules of UnMed. These rules may change from tme to tme n accordance wth the powers of amendment they contan. The member wll be deemed to hae been notfed of any amendment to the rules once the amendment becomes effecte n accordance wth procedures contaned n the rules. A copy of the current rules s aalable from UnMed on applcaton. All members are also bound by the Condtons of Membershp as they relate to the arous health nsurance plans offered by UnMed. The Condtons of Membershp, the Beneft Schedule, and the clams handlng fee are subject to change n accordance wth prealng condtons. Clams for njury or employment related condtons wll only qualfy for coerage proded they meet the crtera set out under secton 11 of the Condtons of Membershp headed Injury or Employment Related Condtons. The addton of other les to the polcy (other than newborn) requres the completon of an applcaton form. Coer wll commence followng the acceptance of the applcaton form by UnMed. Newborn dependants added to the polcy (by notfyng UnMed n wrtng, wthn 30 days, of ther brth) wll not requre the completon of an applcaton form. Dependants Dependants wll contnue to reman on the polcy untl such tme as the member has adsed UnMed n wrtng that coer s no longer requred. Dependant chldren wll on ther 19th brthday become adult dependants and the member wll be requred to pay the premum reflected n that change. If an adult dependant wshes to apply for the same leel of coer wthn one month of no longer qualfyng for coer as a dependant, coer wll be contnuous and there wll be no requrement to complete a new medcal declaraton. In all matters not specfcally coered by the Condtons of Membershp or by the arous documents ssued by UnMed and/or requrng nterpretaton, the decson of UnMed s goernng body shall be fnal. Leels of rembursement ncludng maxmum beneft lmts and excesses, f applcable, are those stated on UnMed s plans as subscrbed to at the tme the costs were ncurred. UnMed shall bear no lablty to any member n respect of the qualty, standard of serce, or effecteness, of any health care serce proded to any person named on the Membershp Certfcate. Whereer n ths document t s stated that UnMed may do, or consent to, any act or thng, UnMed may do or consent to that act or thng n ts absolute, unfettered dscreton, and on such terms and condtons as UnMed n ts absolute, unfettered dscreton, determnes. 17 SUBROGATION In the eent of a payment of, or agreeng to pay, any beneft under your polcy, UnMed shall be subrogated the rght of recoery aganst any person or organsaton. You must not take any acton to prejudce ths rght and cooperate and do all thngs necessary to enable the recoery acton to proceed. 18 DISPUTES UnMed subscrbes to the Insurance & Sangs Ombudsman s scheme. Dsputes n the frst nstance should be made n wrtng to UnMed. If you are not satsfed wth the outcome UnMed wll confrm ts poston n wrtng and you then hae the rght to take the complant to the Ombudsman. PAGE 6

7 GLOSSARY OF INTERPRETATIONS/DEFINITIONS These relate to the Condtons of Membershp, Membershp Certfcate and the Beneft Schedules applcable to UnMed s arous plan optons. ACC means the Accdent Compensaton Corporaton referred to n the Injury Preenton, Rehabltaton and Compensaton Insurance Act 2001 (or ts successor). Accdent means an accdent as defned n the Injury Preenton, Rehabltaton and Compensaton Insurance Act 2001 (or ts successor). Acute means treatment, montorng or hosptal admsson (ether planned or unplanned) proded n response to a sgn, symptom, condton or dsease arsng wthn 48 hours. Adult means a person 19 years of age and oer. Angography means the nestgaton of the cardoascular system by the ntroducton of a contrast medum nto blood essels. Applances means a dece desgned to perform a specfc task. Approed faclty means any prate healthcare faclty approed by UnMed. Beneft Schedule means the range of benefts set out n the arous nsurance plans and plan optons marketed by UnMed and any changes made to those benefts. Chemotherapy drugs means prescrpton medcnes aalable n the communty and subsdsed by the Goernment wth fundng from the Pharmaceutcal budget, prescrbed or recommended by a Regstered Oncologst n Prate Practce for the treatment of cancer or neoplastc dsease as lsted n the Pharmac Schedule, Pharmac approed, and not otherwse excluded by the terms of your polcy. Chld means a person under 19 years of age. Chosen Beneft Schedule means the range of benefts proded under your chosen plan and any changes made by UnMed to those benefts. Chosen Plan means the plan and any plan optons wthn that plan selected by you. Chronc condtons ncludes but s not lmted to spna bfda, scoloss, cystc fbross, pectus excaatum, pectus carnatum, polycystc kdney, and marfans syndrome. Clams handlng fee means an admnstraton cost deducted from your clams refund from the thrd and subsequent clams lodged n an nsurance year. Congental/deelopmental condton(s) means abnormaltes present at brth (as determned by UnMed s Medcal Referee) and ether: (a) dagnosed pror to jonng UnMed, or (b) dagnosed wthn 6 months of brth. Cosmetc treatment means any dagnoss, treatment, surgery, or other procedure undertaken to mproe, alter or enhance appearance, for any reason. Course of treatment means the complete chemotherapy treatment plan for each ncdence of cancer. Dependant means a person who reles on the member for fnancal support as that relates to the payment of premum. Dagnoss means the dentfcaton of the nature of an llness by an examnaton of the symptoms. Detrmental to health means a medcal condton drectly related to the need for dagnoss/treatment/surgery and causng problems for the physcal health of any person coered under the chosen plan. Not Included In coer means condtons, treatments or stuatons that are not coered by your polcy. Glossary of Interpretatons/Defntons means ths document whch forms part of the polcy. Grant means the fxed amount that we wll contrbute towards the cost of certan elgble healthcare serces as specfed n the Beneft Schedule. Health surellance testng means dagnostc test(s), nestgaton(s) or consultaton(s) where there s no apparent symptom suggestng the presence of any llness, dsease or medcal condton the testng s desgned to detect. Insurance year means each twele month perod from your polcy s commencement date. Loyalty Benefts apply to a person who has had no break n coer for the specfed mnmum perod n the same plan. Specfc benefts that qualfy for coerage are as specfed n the Beneft Schedule of the chosen plan. Medcally necessary means any dagnoss, treatment or surgery that n the opnon of UnMed s Medcal Referee s necessary for the care or treatment of the health condton noled. Member means the person n whose name the polcy s ssued and who s responsble for the payment of premums and to whom clams relatng to the member and any others coered by the polcy are pad. PAGE 7

8 GLOSSARY OF INTERPRETATIONS/DEFINITIONS Membershp Certfcate means the most recent Membershp Certfcate ssued to the member by UnMed confrmng the member s Membershp. Mole mappng means the process by whch skn cancers and other skn lesons are frst dagnosed and subsequently montored. Partner means the spouse of the member, or a partner of the member as that term s defned n the Property (Relatonshps) Act 1976 (or any amended or replacement legslaton). Per year means the maxmum enttlement payable to any one person n the frst twele months followng the membershp commencement date and each successe twele month perod n ther chosen plan. Pharmac means the Pharmaceutcal Management Agency establshed by the New Zealand Publc Health and Dsablty Act 2000 (or any successor). Pharmac approed means any drug that s aalable n the communty and subsdsed by the Goernment wth fundng from the Pharmaceutcal budget. Pharmac Schedule means the New Zealand Pharmaceutcal Schedule applyng at the tme of treatment. Plan means one of the nsurance plans proded by UnMed, dstngushed by the specfc Beneft Schedule and plan optons chosen by a member. Polcy means your contract wth UnMed and ncludes:- (a) The Membershp Certfcate. (b) The Condtons of Membershp together wth the Glossary of Interpretatons/Defntons. (c) The Beneft Schedule applcable to your chosen plan. Prescrpton Drug(s) means subsdsed prescrpton medcnes lsted n the Pharmac Schedule, Pharmac approed, and not otherwse excluded by the terms of your chosen plan. Prosthess means an artfcal replacement of an anatomcal structure used to restore functon, such as but not lmted to replacement hps and knees. Qualfyng means those prate healthcare serces whch are:- (a) lsted n the applcable Beneft Schedule; and (b) medcally necessary; and (c) not otherwse excluded under the terms of your polcy. Regstered Medcal Practtoner means a medcal practtoner as that term s defned n the Health Practtoners Competence Assurance Act 2003 (or any amended or replacement legslaton). Regstered Nurse Practtoner means a Practce Nurse holdng current New Zealand Regstered Nurse (NZRN) qualfcatons. Resdent of New Zealand means a person who s enttled to free publc healthcare as determned by the Mnstry of Health. Secondary Care means the proson of any dagnostc tests, treatment, or surgery n a lcensed prate surgcal or medcal hosptal or any other faclty as approed by UnMed. Specfc Benefts means the coer proded for nddually specfed medcal treatments, dagnostc and surgcal procedures and contaned wthn the chosen Beneft Schedule. Subrogaton means that UnMed wll be substtuted for you wth regard to any rght or clam that you mght hae aganst any other person relatng to any clam made under your polcy and approed by UnMed, so that all of your rghts of recoery aganst that person are transferred to UnMed n place of you. Any costs relatng to the recoery process wll be the responsblty of UnMed. Surgery means the treatment of bodly njures or dsorders by ncson or manpulaton, especally wth an nstrument. Surgcal Procedures means nstrumental treatment of njures and dsorders of the body ncludng qualfyng laparoscopc, endoscopc and arthroscopc surgery. Treatment means medcal care for llness or njury. Unapproed medcal serce means any prescrpton drugs, deces, technques, test and/or other serce that, at the sole dscreton of the UnMed Medcal Referee, has ether:- (a) not been approed by UnMed; or (b) whch UnMed determnes are not wdely used or practced n New Zealand. UnMed means Unon Medcal Benefts Socety Lmted, hang ts regstered offce at 165 Gloucester Street, Chrstchurch. UnMed s Medcal Referee s a Regstered Medcal Practtoner engaged by UnMed to prode adce and recommendatons on clncally related matters. Usual and customary charges means the cost of dagnoss/treatment/surgery as determned by UnMed after takng nto account hstorcal payments made for the same or smlar serces. You/your means the member and any other person named on the Membershp Certfcate. PAGE 8