assured and/or the life assured ’ s partner.
policy owner, you, your and yourself
The policy owner listed on the schedule .
life / lives assured The life or lives assured listed in the Schedule.
policy year
The period from the risk commencement date to (but
excluding) the first anniversary date or from an anniversary date to (but excluding) the next anniversary date . The amount payable by you to Sovereign under this policy as detailed in the schedule comprising the cost of the benefits chosen by you plus the policy fee, if any as detailed in the schedule .
material
A statement is material only if that statement would have influenced the judgment of a prudent insurer in fixing the premium or in determining whether he/she would have taken or continued the risk upon substantially the same terms. The maximum amounts payable by Sovereign for each benefit or combination of benefits , as set out in the benefit sheet . A service or supply furnished by a registered medical practitioner is medically necessary if Sovereign determines that it is necessary for the diagnosis, care or treatment of the disease or illness involved. In no event will the following services or supplies be considered to be necessary:
premium(s)
maximum cover
premium due date The date on which the premium is payable under the policy, as agreed with Sovereign .
medically necessary
private hospital
A Sovereign approved privately owned hospital which is licenced as a private hospital in accordance with the Health and Disability Services (Safety) Act 2001.
prophylactic procedure
Procedure undertaken as a preventative measure.
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those that do not require the technical skills of a medical professional; those furnished mainly for the personal comfort and convenience of the person; those furnished solely because the person is an inpatient.
prostheses
The artificial parts used to replace bodily parts when specific types of surgery are undertaken. A hospital service or institution licenced in accordance with the Health and Disability Services (Safety) Act 2001 directly or indirectly owned or funded by the New Zealand Government or any of its agencies. Charges for medical treatment that are determined by Sovereign in its sole discretion to be reasonable and within a range of fees charged under similar circumstances by persons of equivalent experience and pro professional status in the area in which the medical treatment is provided. A subsequent surgery performed within 3 months of an initial surgery for the purpose of treating the same medical condition, where the life assured has had an accepted ‘General surgery performed in a private hospital’ claim and paid any applicable excess. For example, if surgeries are staggered on the
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public hospital
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oral surgeon
A registered medical practitioner who is registered to perform complex oral surgery. Any disease, injury or medical condition for which, prior to becoming covered under this policy, the life assured experienced a symptom, consulted a registered medical practitioner , received treatment or services from a registered medical practitioner , or took prescribed drugs and medicines. The administration fee charged by Sovereign detailed in the policy illustration. The Sovereign illustration enclosed with and forming part of this policy document.
reasonable charges
pre-existing condition
related surgery
policy fee
policy illustration
Page 8 of 9
710 ABH-UMB version 8 Effective 8 April 2022
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