SECTION E - OTHER IMPORTANT INFORMATION GOVERNING THIS POLICY 1 • Where the ACC provides cover for an injury, illness or condition,
INJURY
PREVENTION, REHABILITATION AND COMPENSATION ACT 2001 (KNOWN AS ‘ACC’)
You must obtain approval of the ACC for the provision of treatment in a Private Hospital ; or • Where the ACC approves the claim but declines to pay the costs of surgical treatment. We may meet the cost of that treatment when You provide Us , prior to Your treatment, with a copy of the ACC 's decision; or • Where the ACC accepts Your claim, We will provide Top-Up payments for the difference between ACC reimbursements and Our Usual, Customary and Reasonable charges applicable for surgical and medical costs. • Where the ACC declines Your claim outright, We may require You to appeal the ACC decision through the documented ACC Review Process ( www.acc.co.nz/ claimscare/resolve-issues/ask-for-a-review) or any subsequent appeal process. All appeals must be made within the ACC timeframes of three (3) months post original decision. 2 You can suspend the cover and Total Premium payments under this Superior 3 Health Policy for a period of between three (3) and twenty-four (24) consecutive months if You reside outside of New Zealand for longer than three (3) consecutive months or You have been subject to involuntary redundancy provided the Policy has been in force for at least twelve (12) consecutive months. You must advise Us in writing before going overseas and when made redundant. We must have confirmed in writing that cover is suspended. The Superior 3 Health Policy may not be suspended for less than three (3) consecutive months. We will resume cover without requiring evidence of health for any insured person at the end of the requested period of suspension. Once cover is reinstated, Total Premiums must recommence. We will not pay any benefits under this Superior 3 Health Policy in respect of any event, symptom or condition that You became aware of, or sought treatment or advice for (whether diagnosed or not) that occurred while cover is suspended. The total period of time that Total Premiums may be suspended under this Superior 3 Health Policy is for a period of twenty-four (24) months. If cover for all adult Lives Assured has been suspended, cover for any Children covered by the Superior 3 Health Policy must also be suspended. You may extend cover under this Policy at any time to include: • Your spouse or partner - subject to health evidence and acceptance by Us . • any Child under the age of twenty-one (21) who, in Our opinion, is financially dependent on, and under the legal guardianship of You or Your spouse or partner subject to health evidence and acceptance by Us . If the category of cover specified in the Policy Schedule is either 'single parent' or 'family', additional Children (as defined above) can be insured under the Policy without any increase in Premiums . Otherwise, additional Premiums may be required. You may remove any person insured under the Policy at a Premium due date by written request to Us at least thirty (30) days before that date. Children receive automatic coverage for the first six (6) months after being born, subject to the exclusions specified in the Section G “Exclusions”.
SUSPENSION OF COVER
ADDITIONAL INSURED PERSONS
3
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PC-S3HC-04/2022
[AIA – INTERNAL]
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