p) Home Nursing Benefit This benefit covers the cost of home care provided by a registered nurse , which has been recommended by a Specialist , immediately following the life assured being discharged from a private hospital after having had surgery or medical treatment covered under this MajorCare policy. The amount payable is $300 per day up to $5,000 per policy year per life assured , per annum (no excess applies). q) Waiver Of Premium Benefit If a life assured dies when aged between 21 and 60, Sovereign will continue to provide MajorCare cover for the remaining lives assured , without requiring further premiums for a period of 12 months from the date of death. This does not apply to adult children who have extended cover to their 25th birthday (no excess applies).
applicable benefit in New Zealand dollars, at a health service facility approved by Sovereign .
Treatment outside Australia This benefit covers up to 75% of the reasonable charges for the approved treatment, procedure, consultation, test, diagnostic imaging, support or care, subject to the maximum cover under this policy for the applicable benefit in New Zealand dollars at a health service facility approved by Sovereign and recommended by a New Zealand registered medical specialist . Treatment in and outside Australia Following the treatment, procedure, consultation, test, diagnostic imaging, support or care, a receipt in English needs to be provided to Sovereign , together with any other information reasonably required by Sovereign from the health service provider. All payments made under this benefit will be in New Zealand dollars and will be credited directly to the bank account nominated by the policy owner . We will not accept responsibility for costs associated with any complications during or following any treatment or procedure covered under this benefit that arise as a direct or indirect result of the treatment, procedure, consultation, test, diagnostic imaging, support or care. No cover is available for flights or accommodation. No medical misadventure benefit is payable in relation to any treatment, procedure, consultation, test, diagnostic imaging, support or care covered under this benefit. Prior approval of any claim should be sought or obtained from Sovereign before seeking medical treatment, procedure, consultation, test, diagnostic imaging, support or care. n) Transfer Benefit This specifically covers the transfer of a patient from one Sovereign approved facility to another Sovereign approved facility , in a situation where complications have arisen and further treatment can only be provided by specialist services at the Sovereign approved facility where the patient is being transferred. The benefit only applies to transfers within the boundaries of the North and South Islands of New Zealand, excluding the Chatham Islands, Stewart Island and any other overseas dependencies. All reasonable charges for transfer costs relating to any combination of the following modes of transport will be met; air ambulance, road ambulance, road transport, or economy airfares (no excess applies). o) Bereavement Grant If a life assured dies when aged between 21 and 60, Sovereign will pay a death benefit of $2,500 to the policy owner or their estate (no excess applies).
3. Optional benefit:
Specialists and Tests benefit This benefit applies only if it is shown as an optional benefit in the schedule . After referral from a Registered Medical Practitioner , consultations with Specialists and diagnostic tests are covered. This is regardless of whether they occur within three months before admission and up to three months after discharge from a private hospital , whether for surgical or non-surgical treatment. The maximum amount payable under this benefit is $5,000 per life assured , per policy year per life assured , per annum for all reasonable charges . No excess applies to these benefits. a) The Specialists Benefit Includes: > Specialists fees covered include but are not limited to; Consulting Physician s, Oncologists, General Surgeons, Orthopaedic Surgeons, Neurosurgeons, Ear Nose & Throat Specialists, Cardiac Surgeons, Cardiologists, Gynaecologists, Urologist and Gastroenterologists (Obstetricians and Psychiatrists are specifically excluded): and > Ancillary charges for minor surgery performed in a Specialist ’s rooms where a local anaesthetic is administered.
b) Tests / Diagnostics Covered Include; > Allergy testing
> Angiogram > Audiology > Audiometric tests > Electroencephalography (EEG) > Electromyography (EMG)
Page 4 of 6
126 MAJAP-TC version 8 Effective 5 December 2016
Powered by FlippingBook