Southern Cross Health Insurance (SCHI) has revealed some key policy updates which will be effective from 22 October 2024.
Thursday, August 15th 2024, 6:00AM
The updates are designed to meet the changing needs of the Friendly Society’s 955,000 plus members and to address increases in the cost of healthcare.
Regan Savage, Chief Sales and Marketing Officer for SCHI says, “Our members’ health and wellbeing is at the heart of every decision we make. As New Zealand’s most trusted health insurance brand, it’s important we continue to offer benefits our members value. We’re focused on delivering the Southern Cross vision which is to empower our members to live well for longer. We believe the changes we’re introducing will contribute to this.
“While we are increasing some benefits, we are also very mindful of costs to members and we’re using our contracting tools with Affiliated Providers accordingly. We’re also making it easier for our members to engage with Southern Cross and re-writing many of our policy documents in plain language to make sure members are better informed about their cover and how to get the help they need. We are also removing excesses on some benefits.
Our team has been working on product improvements to benefit our membership for the majority of our policies¹ since the end of 2022. We listen carefully to our members’ feedback and look forward to seeing the positive impact for them.”
Policy documents are easier to understand. Our UltraCare, Wellbeing One and Two, KiwiCare and RegularCare and HealthEssentials policy documents have been re-written in plain language so they are easier to understand. Plus, we’ve used a clearer layout, structure and provided examples, to help make these policy documents simpler to navigate. SCHI has earned WriteMark Plus accreditation for these policy documents, which shows that, in addition to meeting the set of established plain language criteria, content has been rigorously tested with real members.
Enhanced cover for breast reduction and breast symmetry. We’ve enhanced cover for breast reduction and breast symmetry. This includes increased lifetime limits for these procedures under Wellbeing One, Wellbeing Two, KiwiCare, RegularCare, UltraCare and the removal of the restriction of one procedure per lifetime and the requirement that a breast symmetry surgery must take place within two years of the first eligible breast reconstruction following an eligible mastectomy from all plans with cover for breast reduction and breast symmetry.
We’re removing the excess requirement on certain benefits for plans with an excess making it easier for our members to claim, for example on surgical allowances, obstetrics and under the GP minor surgery benefit. For plans with an excess, the excess will only apply to claims for surgical procedures, chemotherapy for cancer (including Cancer Cover Plus) and radiotherapy. The excess will apply to each person covered under the policy once each claims year.
More choice under psychiatrist consultation benefit. We’re making it easier for members with this cover to access a psychiatrist by removing the requirement that the consultations must be with an Affiliated Provider.
More choice and higher benefit limit per year for mental health consultations for UltraCare members. Improved access to mental health services with a more flexible mental health consultation benefit and an increased annual limit for mental health consultations. The existing separate benefits for psychiatrist consultations and clinical psychologist consultations will be removed and replaced with a new "mental health consultations" benefit. There will also no longer be a requirement that psychologists must be clinical psychologists.
We’re making more healthcare services Affiliated Provider-only (this applies to all plans except UltraCare and HealthEssentials). We’ve contracted more healthcare services which must be provided by an Affiliated Provider. This helps to manage our costs so we can keep premiums as affordable as possible.
List of Affiliated Provider-only healthcare services will only be available online. The list of healthcare services that must be performed by an Affiliated Provider will be moved out of the relevant policy documents and will only be available on the Southern Cross website. This will make it quicker for us to introduce cover for new healthcare services through our Affiliated-Provider network. We’ll keep this information up-to-date, and members will need to check the website for our current list. They can view this online where it will be updated on 22 October 2024.
We’re revising our policy exclusions section, adding examples to aid understanding, removing words where they did not change the meaning, updating terminology and combining exclusions under the same heading where appropriate.
We’re also changing the following policy exclusions:
○ For plans that include cover for prescriptions or physiotherapy; prescriptions or physiotherapy that are related to pregnancy or childbirth will be covered (up to the policy limits).
○ For plans that include cover for chemotherapy; transfusion or injection of autologous blood or blood products will be covered when used as part of eligible chemotherapy treatment.
○ For plans which include an exclusion for substance abuse, intoxication or drug taking, this exclusion has been revised to remove the reference to intoxication so that only the abuse of substances such as alcohol or drugs and drug taking are excluded, so that intoxication is no longer an exclusion on its own.
We’ve clarified the documents that form part of a member’s policy and introduced a new list of policy variations. The following documents have been added to the list of documents that form part of a member’s policy:
○ application form,
○ health insurance medical declaration (where relevant),
○ membership certificate
○ and the list of policy variations.
The list of policy variations is a list of variations to policy terms and conditions, published on our website, that may apply from time to time. These variations include the way we treat some exclusions and certain benefit terms or new ways of delivering healthcare services we’re testing.
We’re changing how we communicate changes to certain documents that may form part of a member’s policy. The following documents are regularly updated as we continuously review how we cover healthcare services and certain health technology:
○ the eligibility criteria,
○ the list of unapproved healthcare services,
○ the list of prostheses and specialised equipment,
○ the list of Affiliated Provider-only healthcare services
○ and our new list of policy variations.
This means members may not get direct communications for all changes to these documents, and they’ll need to refer to our website for the latest versions. These will all be updated on 22 October 2024.
Southern Cross is committed to continual improvement
Savage says, “This review required a great deal of research, system development, negotiation with health services providers and clear communications with our members. We trust the broker and adviser community will also recognise the policy changes as contributing to their clients’ wellbeing.
“Healthcare is dynamic and fast-changing. Health technology, drugs, and healthcare services are constantly being improved, so Southern Cross regularly reviews benefits and the way we engage with members, all while aiming to remain sustainable and affordable.
“We’re driven to support our members’ healthcare journey, enabling them to live well for longer. That’s one thing that will never change.”
WriteMark CEO Lynda Harris said the policies showed an impressive commitment to plain language.
“Plain language insurance policies build trust. They let customers know you’re in their corner — not hiding behind fine print and legalese.
“Southern Cross Health Society has gone the extra mile to achieve the WriteMark Plus for their customers. The policies have been through user testing to make sure they’re practical, clear, and they work for readers.”
Note:
Not all changes apply to all policies. Policy terms, conditions and exclusions apply. Your clients and members may view their policy details and current policy wording on MySouthernCross from August 20. A summary of the changes will be available on the Adviser Gateway from August 19 and new policy documents will be available online. If you would like to discuss these changes further, please contact your Business Development Manager.
¹Not all changes apply to all policies. Critical Illness and Cancer Assist policies were out of scope for changes as part of the product review.
