Unfunded and Non-Pharmac for Southern Cross and other providers

Unfunded and Non-Pharmac for Southern Cross and other providers

So you have existing medical insurance cover but you are concerned about unfunded and non-Pharmac subsidised medicines, especially for cancer.

You are concerned because your present cover is either limited or non-existent for this area of your medical treatment. 

If you are fit and healthy then this is not quite the issue it could be and moving to a plan that does cover this is relatively straight forward. 

But that’s not the reason you are reading this either.

You have medical insurance cover, and it covers your pre-existing conditions but it does not cover the unfunded medicines issue for you. 

You’ve acquired your cover through a work scheme, took it early enough or you had it as a kid and your pre-existing conditions are all nicely covered. 

You do not want to move and not be covered for these conditions, but you don’t want to take a whole new plan and double the costs either. Good!

We are both on the right track here. 

You don’t have to lose your pre-existing condition cover, you don’t have to switch provider, and you don’t have to take a whole new plan either.

Well yes, there is a new plan, but it’s not quite a whole new plan. What we are doing in utilising the product options in the market to your advantage.

In reality our approach to this work best with Southern Cross policies because Southern Cross does have some contribution to unfunded medicines which we can utilise at claim time to minimise any out of pocket expenses.

If you have an older style 80% plan and you don’t want to face underwriting with your present provider and lose the 80% cover you do have, we can help with that too.

So who do we want to talk to?

If you hold a medical insurance policy with:

  • Southern Cross (majority of the health insurance market)
  • AA Health
  • Accuro excluding the + (plus) plans
  • AIA excluding Real Health
  • BNZ
  • NIB Excluding Ultimate Health Max
  • State
  • Unimed
  • Tower/nib Easy Health and Premier Health
  • OnePath/nib Major Medical excluding Major Medical Deluxe

The last two are now managed by nib, you may have acquired them with their original company and haven’t had an update other than increases in premiums due to moving house etc. 

If so, get in touch and we can assist with updating your details to your insurer can keep you informed.

I have excluded Partners Life and Sovereign from this list as their products cover unfunded medicines.

Sovereign are an interesting example of a typical insurer.

They have had a number of different plans over the years and some have and some have not had unfunded medicines included.

To give you the run down:

  • MajorCare cover taken before November 2003 has cover for unfunded medicines. 
  • MajorCare cover taken before October 2001 also has cover for preventative screening. Not well known or utilised. But you can ask for a colonoscopy and they will pay, not sure why you would do that if you didn’t have symptoms but you can.
  • MajorCare taken after November 2003 has cover for unfunded cancer medicines, this was applied in October 2016 and is relatively recent.
  • Absolute Health which was launched in October 2003 has had the same treatment with unfunded cancer treatment now included.
  • Private Health & Private Health Plus, launched in 2015 has unfunded cancer treatments included.

The one thing across all of this that is a risk is the majority of insurers can make changes to policy wordings within 30 days and remove benefits. 

This is of concern to us for you as a policyholder, as you are relying on your medical cover to front with $1-200,000 for treatment at a critical time. You don’t want to be in a position where you unfunded treatment could be removed and leave you without options.

We recommend, where possible, medical insurance policies that have wording guarantees. Guarantees that the insurer cannot take away from the cover you initially purchased. 

The better ones have upgrade provisions, where enhancements are applied to older policies.

Where does this risk lie for you?

Provider and Policies with 30 day right to change policy wordings

  • AA Health
  • Accuro
  • BNZ
  • nib policies that are not Ultimate Health Max and Major Medical Deluxe (Old OnePath Product)
  • Southern Cross
  • Sovereign MajorCare after November 2003
  • Sovereign Absolute Health
  • Sovereign Private Health & Private Health Plus
  • State
  • Unimed
  • Tower/nib Easy Health & Premier Health
  • OnePath/nib Major Medical excluding Major Medical Deluxe

Hopefully, I’ve made sense and allayed some fears with those that actually have cover. 

If you don’t have unfunded provisions for your policy, get in touch or give us a call to discuss adding an unfunded medicines module to your existing medical cover.

The information is only intended to be of a general nature and should not be relied upon in any part without obtaining full details of the products and services by contacting Willowgrove Consulting Limited. 

All product and service details, terms, conditions and other information are subject to change at any time without notice. 

Terms, conditions and fees apply to the various products and services and are available on request. 

A disclosure document will be provided to you on request free of charge.

sources: Strategy Life Risk Insurance Analysis, Hospital & Hospital, Specialist & Diagnostics Tests cover October 2016, Sovereign Policy wordings and adviser updates, various dates.

Jon-Paul Hale

Written by : Jon-Paul Hale

1000 Characters left

Physical Address:
5i Miro Place

Email: enquiry@willowgrove.co.nz
Phone: 09 973 2849

Postal Address:
PO Box 301792