> _Markdown transcription of UniMed Hospital Select policy wording, effective 2018-01-25. Source: https://www.unimed.co.nz/wp-content/uploads/2017/12/79553-UniMed-Hospital-Select-Plan-6pp-August-2017-UNI96-3_HR.pdf_ --- # HOSPITAL SELECT PLUS MODULES PLAN It's the security of knowing we're there. ## PLEASE NOTE - All benefits in all sections apply to each person on the policy unless otherwise stated. - Excess Option: Any voluntary excess option selected applies per claim and will be additional to any other deductibles applying to this plan. - Hospital Select is the base plan to which the other modules may be added, individually or together, with the exception of Module "D" which cannot be added to Hospital Select Base Plan on its own. - All benefits included in this brochure are net of any social security refund and include GST charged by providers of service. ## HOSPITAL SELECT BASE PLAN ### PRIVATE HOSPITALISATION SURGICAL BENEFITS THE FOLLOWING SECTION REFUNDS 100% OF THE USUAL AND CUSTOMARY CHARGES, LIMITED TO THE BENEFIT MAXIMUMS FOR ANY ADMISSION. #### Surgery An admission for Non Acute Qualifying "Surgical Procedure(s)", together with that procedure's associated recovery time, performed by a Registered Medical Specialist in a Licensed Private Surgical Hospital | Item | Per Admn | Per Year | |------|----------|----------| | Surgeon's fee | 300,000.00 | 300,000.00 | | Anaesthetist's fee | | | | Hospital fees, in a Licensed Private Hospital or Private Facility approved by UniMed for: | | | | • Accommodation | | | | • Theatre fees and Anaesthetic Supplies | | | | • Perfusionist | | | | • Intensive Care and special In-Hospital Nursing | | | | • Recovery Nurse | | | | • X-Ray examination, ECG | | | | • Intravenous Fluids, Irrigating Solutions, Dressings, Prescriptions and Antibiotics | | | | • Post Operative Physiotherapy fees from a Registered Physiotherapist | | | | • Emergency Ambulance for hospital admission | | | | • Surgically Implanted Prostheses | | | | • Laparoscopic Disposables | | | #### Post-operative Occupational Therapy Treatment by a Registered Occupational Therapist. | Per Visit | Per Surgical Admission | |-----------|----------------------| | 100.00 | 3 Visits | #### Surgical Tests & Investigations | Item | Per Admn | Per Year | |------|----------|----------| | Gastroscopy | 1,800.00 | No Max | | Colonoscopy | 2,500.00 | No Max | #### Surveillance Colonoscopy or Gastroscopy Payable where no signs or symptoms are present, reimbursement of 50% of actual costs up to limit. Limit of one procedure every 24 months. | Item | Per Admn | Per 24 Months | |------|----------|---------------| | Gastroscopy | 900.00 | 900.00 | | Colonoscopy | 1,250.00 | 1,250.00 | #### In-Patient Non-PHARMAC Subsidised Pharmaceuticals Pharmaceuticals prescribed by a Consulting Physician, Paediatrician or Specialist Registered Medical Practitioner which have been approved by Medsafe and are not fully or partly subsidised by PHARMAC through the New Zealand Pharmaceutical Schedule. | Per Year | |----------| | 2,000.00 | #### Oral Surgery All Oral Surgery performed by a Registered Oral Surgeon excluding, under all benefit categories, the extraction or surgical removal of teeth, implantation of teeth or costs of titanium implants. Wisdom tooth extraction including the removal of un-erupted or impacted wisdom teeth, including all associated costs. | Per Admn | Per Year | |----------|----------| | 300,000.00 | 300,000.00 | #### Breast Reconstruction Breast Reconstruction performed by a Registered Medical Practitioner in Private Practice. For all stages of breast reconstruction performed under the same anaesthetic as the initial mastectomy: benefits as per Private Hospitalisation Surgical Benefits section. For all stages of breast reconstruction performed after the initial mastectomy or not under the same anaesthetic as the initial mastectomy, an amount (payable once only) being the lesser of either the total cost of the reconstruction (including nipple reconstruction and tattooing); or $15,000. For the avoidance of doubt, this benefit section excludes surgery to the breasts to achieve or correct the symmetry and/or look and/or feel of the breasts. This benefit is only available for surgery following first diagnosis of breast cancer on or after 01 May 2005 and no benefit will be paid under this section unless UniMed has paid for the initial mastectomy. #### Angiography Angiograms & Angioplasty including hospitalisation, specialist & ancillary fees | Per Admn | Per Year | |----------|----------| | 300,000.00 | 300,000.00 | #### Lithotripsy Performed by a Registered Medical Specialist Special conditions apply, refer to full conditions of membership. | Per Admn | Per Year | |----------|----------| | 300,000.00 | 300,000.00 | #### Accident Surgery Before Qualifying "Surgical Procedures" are undertaken UniMed must receive written confirmation from the "ACC" regarding their decision to either accept or decline your claim for surgery. Qualifying Injury Claim(s) that the "ACC" agree to accept will also be accepted by UniMed for "top-up" coverage to the benefit levels applicable to the "Private Hospital Surgical Benefits" section. If "ACC" decline your claim UniMed will, at its sole discretion either assist with the total cost of surgery or pay the difference between the actual cost of surgery and what the "ACC" would have contributed had your claim been accepted by them to the levels applicable to the "Private Hospital Surgical Benefits" section. No cover is provided for workplace/employment related injuries/conditions first occurring on or after 1 July 1999. The first $100 of the TOTAL refundable cost per admission under this benefit are payable by the patient/member. #### Obesity Surgery Benefits apply after five years' continuous membership in this plan. A one-time grant is payable of 50% of actual costs up to the benefit limit. Special conditions apply and are available on request. | Per Grant | |-----------| | 8,000.00 | #### Overseas Treatment Benefits apply after five years' continuous membership in this plan. A grant is payable of 75% of usual and customary charge for the identical procedure in New Zealand. The procedure must be available in New Zealand but the member prefers to be treated overseas. The procedure must be performed by a medical practitioner who is registered to carry out the procedure in the country where the procedure is taking place. A referral for the procedure from a New Zealand Registered Medical Practitioner will be required. Reimbursement of travel or accommodation costs is excluded. Benefit payable as reimbursement on production of invoices. Prior approval is required for the treatment to be eligible. #### Sterilisation Sterilisation procedures are covered after three years continuous membership in this plan | Per Admn | Per Year | |----------|----------| | 5,000.00 | 5,000.00 | #### Home Nursing – Following Surgery Home Nursing by a Registered Nurse, following surgery in a Private Hospital on referral from a Registered Medical Practitioner | Per Day | Per Year | |---------|----------| | 150.00 | 6,000.00 | #### Speech and Language Therapy Treatment by a Registered Speech Therapist following surgery, excluding consequence of injury by accident (see separate benefits). | Per Visit | Per Year | |-----------|----------| | 80.00 | 400.00 | #### Ambulance Emergency transportation for Public Hospital inpatient admission | Per Year | |----------| | 200.00 | #### Parent Support Accommodation In the event of a policyholder's insured child having surgery in a private hospital for which cover is available, a benefit for parent accommodation in the hospital is payable of: | Per Night | Per Year | |-----------|----------| | 150.00 | 600.00 | #### Hospital Cash Allowance – Medical/surgical admissions When admitted to Public Hospital for a full 24 hours or more. Child Benefit - 50% of above. (All injury admissions excluded) | Per Day | Per Year | |---------|----------| | 125.00 | 1,500.00 | ### IMAGING | Item | Per Year | |------|----------| | CT Scan | 3,000.00 | | MRI Scan | 4,000.00 | | PET Scan | 2,500.00 | | Cardioversion | 300,000.00 | | Myocardial Perfusion Scan | 300,000.00 | | Scintigraphy | 2,000.00 | ### IMAGING (six months prior and six months after surgery) | Item | Per Year | |------|----------| | X-rays | 300,000.00 | | Mammography | | | Ultrasounds | | | Nuclear Scanning | | ### SPECIALISTS (six months prior and six months after surgery) | Item | Per Year | |------|----------| | Consulting Physician/Paediatrician - Consultation following referral from a Registered Medical Practitioner | 300,000.00 | | Specialist Oncologist - Consultation following referral from a Registered Medical Practitioner with an Oncologist who is a Specialist Registered Medical Practitioner | | | Specialist/Surgeon - Consultation following referral from a Registered Medical Practitioner | | | Oral Surgeon - Consultation (not treatment) by a Registered Oral Surgeon | | ### Medical Hospitalisation Cover is provided for Non Acute Medical Hospitalisation (Excludes Psychiatric/Geriatric) in a Licensed Private Hospital, on admission and under the care of a Registered Medical Practitioner. | Per Year | |----------| | 65,000.00 | Ancillary hospital charges: 500.00 ### Radiation Oncology Benefit payable for treatment classified as either Urgent or Curative using Ministry of Health guidelines. Including Planning, Shielding and Accessories, Field Setup and XRT Simulation and performed in an approved Private Hospital facility. Special conditions apply and are available on request. | Per Year | |----------| | 30,000.00 | ### Chemotherapy Benefit payable for treatment by a Registered Oncologist in Private Practice. Benefit applies to the cost of materials, Chemotherapy drugs per course which are PHARMAC approved, plus Hospital Accommodation together with approved ancillary hospital costs. | Per Treatment | Per Year | |---------------|----------| | 30,000.00 | 65,000.00 | ### Acute Private Hospitalisation Medical/Surgical grant An admission for an "Acute" Qualifying Medical Condition or "Surgical Procedure" under the care of a Registered Medical Practitioner in a Licensed Private Hospital | Per Year | |----------| | 5,000.00 | ### Psychiatric/Geriatric Hospitalisation In a Licensed Private Hospital, on admission and under the care of a Specialist Psychiatrist/ Geriatrician. Refund of Hospital Accommodation fees | Per Year | |----------| | 2,000.00 | Ancillary hospital charges: 500.00 ### MINOR SURGERY #### Registered Medical Specialist Not requiring general anaesthetic, including preceding consultation and performed in specialist rooms | Per Year | |----------| | 300,000.00 | #### Registered Medical Practitioner Not requiring general anaesthetic, including preceding consultation performed in practice rooms per procedure | Per Procedure | |---------------| | 500.00 | ### OVERSEAS TREATMENT In the event of Heart, Lung, or Liver transplant surgery being required outside New Zealand, UniMed will assist with a once only grant | Grant | |-------| | 20,000.00 | ### WAIVER OF PREMIUM Upon death by natural causes prior to age 60 of any member paying the adult contribution rate the surviving spouse and/or qualifying dependents named on the policy will receive two years free coverage at the benefit levels applying at the date of death. ### FUNERAL GRANT Upon death by natural causes prior to age 65 of any person on the policy a grant towards funeral costs is available. | Amount | |--------| | 2,400.00 | ### "ACC" TOP UP BENEFIT The 'shortfall' between actual costs and ACC refunds for out of hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits as shown within this option. NB: For a claim to qualify, ACC must have provided financial assistance towards treatment costs. --- ## SPECIALISTS - MODULE "S" THE FOLLOWING BENEFIT SECTIONS REFUND 100% OF ACTUAL MEDICAL COSTS TO THE SPECIFIED MAXIMUMS. ### Imaging | Item | Per Year | |------|----------| | Bone density scan | 5,000.00 | | X-rays | | | Mammography | | | Ultrasounds | | | Nuclear scanning | | | Holter monitoring | | | Exercise ECG | | | Blood pressure monitoring | | | Stress echocardiography | | | Cardiovascular ultrasound | | | Echocardiography | | | Transoesophageal Echocardiography | | | Urodynamic assessment | | | Audiology | | ### SPECIALISTS | Item | Per Year | |------|----------| | Consulting Physician/Paediatrician - Consultation following referral from a Registered Medical Practitioner | 5,000 | | Specialist Oncologist - Consultation following referral from a Registered Medical Practitioner with an Oncologist who is a Specialist Registered Medical Practitioner | | | Specialist including Surgeon - Consultation following referral from a Registered Medical Practitioner | | | Oral Surgeon - Consultation (not treatment) by a Registered Oral Surgeon | | ### Obstetrics Treatment by a Registered Medical Practitioner for obstetric conditions | Per Year | |----------| | 1,000.00 | ### "ACC" TOP UP BENEFIT The 'shortfall' between actual costs and ACC refunds for out of hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits as shown within this option. NB: For a claim to qualify, ACC must have provided financial assistance towards treatment costs. --- ## DAY TO DAY - MODULE "G" THE FOLLOWING BENEFIT SECTIONS REFUND 100% OF ACTUAL MEDICAL COSTS TO THE SPECIFIED MAXIMUMS. ### General Practitioners Treatment and consultation by a Registered Medical Practitioner, including dressings, acupuncture, ECG. | Per Visit | Per Year | |-----------|----------| | 55.00 | No Limit | ### After Hours Home Visits | Per Visit | Per Year | |-----------|----------| | 70.00 | No Limit | ### Registered Practice Nurse Treatment and consultation by a Practice Nurse holding NZRN qualifications. | Per Visit | Per Year | |-----------|----------| | 35.00 | No Limit | ### Independent Nurse Practitioner Treatment/Consultation | Per Visit | Per Year | |-----------|----------| | 30.00 | 150.00 | ### Prescriptions User part charges for prescription items subsidised by PHARMAC through New Zealand Pharmaceutical Schedule, prescribed by a Registered Medical Practitioner (Note: Maximum of 20 items per policy). | Per Visit | Per Year | |-----------|----------| | No Limit | 400.00 | ### Non-PHARMAC subsidised pharmaceuticals Pharmaceuticals prescribed by a Registered Medical Practitioner in General Practice which have been approved by Medsafe and are not fully or partly subsidised by PHARMAC through the New Zealand Pharmaceutical Schedule. | Amount | |--------| | 1,000.00 | ### Laboratory Tests The cost of laboratory charges for occult blood or glucose tests, requested by a Registered Medical Practitioner | Per Visit | Per Year | |-----------|----------| | No Limit | 75.00 | ### "ACC" TOP UP BENEFIT The 'shortfall' between actual costs and ACC refunds for out of hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits as shown within this option. NB: For a claim to qualify, ACC must have provided financial assistance towards treatment costs. ### LOYALTY BENEFIT #### Psychiatric Consultations Benefits apply after 5 years' continuous cover in this plan option. Consultation with a psychiatrist who is vocationally registered in New Zealand. | Per Visit | Per Year | |-----------|----------| | 150.00 | Three Visits | --- ## NATURAL HEALTH - MODULE "N" THE FOLLOWING BENEFIT SECTIONS REFUND 100% OF ACTUAL MEDICAL COSTS TO THE SPECIFIED MAXIMUMS. ### Osteopath Consultation and treatment provided by an Osteopath with NZ Registration | Per Visit | Per Year | |-----------|----------| | 50.00 | 200.00 | ### Chiropractor Services from a Registered Chiropractor including X-rays. | Per Visit | Per Year | |-----------|----------| | 50.00 | 200.00 | ### Treatment provided by the following Registered Practitioners - Chiropodist - Physiotherapist - Dietitian - Podiatrist - Acupuncture - Homeopathy - Naturopathy - Nutritionist - Medical Herbalist - Remedial Massage Therapy | Per Practitioner Per Visit | Per Practitioner Per Year | Combined Maximum Per Year | |---------------------------|--------------------------|---------------------------| | 50.00 | 200.00 | 800.00 | ### Wellness benefit A health check by a Registered Medical Practitioner | Amount | Frequency | |--------|-----------| | 100.00 | Every three years | ### "ACC" TOP UP BENEFIT The 'shortfall' between actual costs and ACC refunds for out of hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits as shown within this option. NB: For a claim to qualify, ACC must have provided financial assistance towards treatment costs. --- ## DENTAL & VISION - MODULE "D" THE FOLLOWING BENEFIT SECTIONS REFUND 100% OF ACTUAL MEDICAL COSTS TO THE SPECIFIED MAXIMUMS. ### Orthoptist Treatment by a Registered Orthoptist | Per Visit | Per Year | |-----------|----------| | | 300.00 | ### Optometrist Consultation by a Registered Optometrist NB: Vision testing only, for spectacles/lenses see below. | Per Visit | Per Year | |-----------|----------| | 75.00 | 300.00 | ### Spectacles and Lenses Reimbursement of costs (excluding replacement for loss or breakage) of spectacles or contact lenses providing a change in prescription is required. | Amount | |--------| | 500.00 | ### Dental Dental treatment by a Registered Dental Practitioner including routine maintenance, fillings, extraction of teeth, dentures, periodontic and orthodontic treatment. | Amount | |--------| | 500.00 | ### Dental Hygienist Treatment by a Hygienist registered with the NZ Dental Hygienist Association. | Amount | |--------| | 100.00 | --- ## Contact Information ### Need to know more before making your choice? Phone UniMed's friendly, helpful staff now and secure your future. If calling from Christchurch please phone 03 365 4048. **TOLL FREE 0800 600 666** ### Head Office Union Medical Benefits Society Ltd 165 Gloucester Street PO Box 1721, Christchurch 8140 Phone: 03 365 4048 Fax: 03 365 4066 www.unimed.co.nz