This benefit only provides coverage for the medically necessary: > Excision of lesions, moles and cysts; > Wedge resection of toenails; > Allergy desensitisation injections; This benefit also provides cover for Vasectomy after two continuous years of cover. The vasectomy does not need to be medically necessary. j) Caregiver Accommodation Benefit The caregiver accommodation benefit is available for a parent, guardian or support person who accompanies a life assured (under the age of 21) where the life assured is receiving treatment and overnight accommodation is required. This allowance is also available to any support person who accompanies a patient being transferred under Section 2n of this MajorCare benefits sheet . The amount payable under the caregiver accommodation benefit is $300 per day up to $3000 per annum (no excess applies). Sovereign will reimburse these costs up to the maximum on receiving proof of expenses incurred. k) Public Hospital Cash Grant This benefit is payable if a life assured is admitted to a public hospital for more than three days (not including admissions on a private fee paying basis). For the purposes of this benefit, a “day” must include an overnight stay. The amount payable under this benefit is $300 per day after the third day, up to a maximum of $3,000 per life assured , per policy year, per life assured per annum (no excess applies). l) Overseas Medical Treatment Benefit This benefit covers medical treatment at an overseas hospital acceptable to Sovereign , where medical treatment covered under this MajorCare policy cannot be provided in New Zealand. A Specialist must recommend medical treatment, and prior approval from Sovereign must be sought or obtained prior to seeking the medical treatment. The amount payable under this benefit is a maximum of $30,000 per policy year per life assured per annum. The maximum amount payable includes two return economy class airfares for the life assured and a support person (no excess applies).
> the medical condition and treatment comply with Sovereign’s criteria for the benefit entitlement. The maximum amount payable for this benefit is $6,000 per life assured . To be eligible for this benefit prior approval of any pending claim must be sought or obtained from Sovereign before any costs are incurred. Surgery to remove breast implants or surgery for reconstructive work relating to breast implants is specifically excluded under this policy.
g) Breast Symmetry Surgery Following Mastectomy Benefit
MajorCare pays a maximum of all reasonable charges up to $5,000 per life assured per life of the time. No excess is payable for any claims under this benefit. Following mastectomy, covers costs up to the maximum cover for procedures on the unaffected breast to achieve breast symmetry. This will be available either during or following a mastectomy, which has been covered by you r Sovereign health policy. Procedures covered under this benefit may include breast reduction surgery. The procedures to achieve breast symmetry do not need to be medically necessary. Prior approval of any claim should be sought or obtained from Sovereign before seeking medical treatment. h) Varicose Veins Benefit In special circumstances Sovereign will cover treatment for varicose veins. This benefit applies after a life assured has had or you have had cover in place for a minimum continuous period of 3 years from the risk commencement date of your policy. Sovereign will cover sclerotherapy and surgical treatment for varicose veins where: > a Specialist provides a medical report confirming that the treatment is medically necessary and that the treatment is not being carried out for cosmetic reasons; and > the medical condition and treatment comply with Sovereign ’s criteria for the benefit entitlement. Prior approval of any claim should be sought or obtained from Sovereign before seeking medical treatment. i) Non-Specialist Outpatient Minor Surgery Benefit MajorCare pays a maximum of all reasonable charges up to $500 per life assured per treatment to a maximum of $1,000 per life assured per policy year. No excess is payable for any claims under this benefit. Covers reasonable charges incurred with any of the following outpatient surgical procedures performed by a registered medical practitioner under local anaesthesia in general practice surgery rooms.
m) Voluntary Treatment Overseas Benefit Treatment in Australia
This benefit covers the costs for the approved treatment, procedure, consultation, test, diagnostic imaging, support or care, subject to the maximum cover under this policy for the
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126 MAJAP-TC version 8 Effective 5 December 2016
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