1 . What are your policy benefits Your Sovereign health insurance policy can provide financial assistance if you incur major medical expenses. Details of the benefits you have chosen and the names of the people insured for the benefits (called the life or lives assured ) are shown in the schedule . Provided your claim is accepted and subject to clause 7(b), Sovereign will pay the benefits to you as the policy owner , the registered medical practitioner or facility or to your estate. The benefits provided are detailed in the separate benefit sheet . It is Sovereign ’ s normal business practice to review the Absolute Health benefits on a regular basis. This is to ensure it continues to provide cover for current medical treatments for common medical conditions at the time. It is also to ensure the insurance product remains commercially viable for Sovereign . A review of the Absolute Health benefits may result in Sovereign changing the Absolute Health benefits and updating this policy document accordingly. The following are examples of circumstances when Sovereign may wish to change the Absolute Health benefits for all policy owners : > To increase the level of Absolute Health benefits under the policy or to add new Absolute Health benefits; > To move all policy owners to a refreshed policy document with a new drafting style/layout and similar levels of Absolute Health benefits; > To allow for an unexpected increase in the type or level of claims that will not be sustainable long term based on the current schedule of premium rates or at any premium rates (uninsurable); > To take account of a significantly escalated or new public health threat e.g. a pandemic. Sovereign will give you at least 30 day s’ notice of any pending Absolute Health benefit and policy document change. Such notice will include an updated Absolute Health policy document and Absolute Health benefit sheet highlighting any change to the Absolute Health benefits and will confirm the actual date from which the revised Absolute Health benefits and policy changes will take effect. You always retain the right to cancel this policy at any time – see Clause 7 When can your policy be cancelled.
b) Method of paying premiums
You must pay all premiums to Sovereign . Premiums can be paid by direct debit, credit card or debit card. Premium payments are not effective until after they have been cleared and credited to our bank account.
c) What happens if you do not pay the premium on time?
You have 30 da ys’ grace in respect of any premium due. Sovereign will be entitled to cancel your policy by written notice to you at your last known address if a premium remains outstanding 31 days after a premium due date . If you want to have this policy reinstated, you must write to Sovereign . Sovereign does not have to reinstate this policy but may do so on any conditions it considers appropriate. If a premium is due but unpaid, Sovereign shall not consider a claim until the premium is paid.
d) Changes in premium amount
It ’ s Sovereign ’ s normal business practice to review premiums on a regular basis. This is usually done each year on the policy anniversary date . Premium increases will always be applied across a class of business. No increase in premium will apply to your own policy based on your own claims experience. Premiums for benefits are age related, unless otherwise agreed to by Sovereign . Premiums will increase each year and such premium increases will usually take effect from the anniversary date . Any policy fee will normally increase each year on the anniversary date in line with the consumer price index . The other circumstances in which your premium will change are when you :
> add or remove optional benefits or adjust the excess ; or
> add or delete a life or lives assured to/from this policy.
3 . How to make a claim
For any claim enquiries and prior approval claims, you should call the Sovereign Claims Hotline on 0800 166 377. A claim form can be downloaded from Sovereign ’ s website (www.sovereign.co.nz).
2 . Your premiums
There are two ways to make a claim:
a) Premium
> you can seek prior approval from Sovereign in
To ensure that your policy remains in force you must pay the premium on a regular basis as agreed with Sovereign . The initial premium is shown in the schedule , the first payment of premium is due to Sovereign on the first premium due date , which normally coincides with the risk commencement date . The premium may change from time to time (as described below) and you will need to pay the new premium from the next premium due date and thereafter. Sovereign will advise you in writing of the new premium at least 30 days before the change takes effect.
accordance with section 3a below and we will arrange to pay the life assured ’ s registered medical practitioner or facilities directly, less any excess ; or > you can pay for the medical costs incurred yourself and then submit your claim to Sovereign for reimbursement in accordance with section 3b below. Sovereign strongly recommends that you utilise our prior approval service at all times. This will ensure that Sovereign approves or declines your claim before you incur any costs.
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710 ABH-UMB version 8 Effective 8 April 2022
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