6. Maximum amounts payable relating to prostheses and Disposable Laporascopic Equipment Costs relating to these items will be reimbursed in accordance with the Sovereign benefit maximums listing. When pre-approving a claim, Sovereign will quote the Sovereign benefit maximums payable for the relevant item. 7. New Healthcare Technology and Treatments Cover will be extended to incorporate new technologies and treatments when Sovereign ’s medical advisory panel is satisfied that improved clinical outcomes will be achieved and that the medical treatment, procedure or product meets all of the appropriate regulatory requirements. 8. Public Hospitals Medical treatment carried out in a public hospital or under the direct control of a public hospital will be covered to the limits specified in the schedule if approved by Sovereign and if the “Protocols for the Treatment of Private Patients in a Public hospital ” specified by the Ministry of Health have been followed.
No amount will be paid under MajorCare for the following expenses: > Organ donation and receipt, except for reimbursement under the overseas medical benefit; > General Practitioner ’s costs except for sterilisation benefit, as specified in Section 3c; > Treatment or procedure not provided by an eligible provider ; > Treatment provided by a public hospital except where expressly covered under MajorCare; > Physiotherapists (except where expressly covered under MajorCare), chiropractors, osteopaths, naturopaths, homeopaths, acupuncturists, obstetrics and podiatrist’s costs; > Nursing costs (except where expressly covered under MajorCare); > Dentist s’ costs (except for oral surgery, which is expressly covered under MajorCare - special conditions apply); > Prescription charges (except where expressly covered under MajorCare); > Any charge for non-essential, or, personal items, while the life assured is an inpatient in any Sovereign approved facility (for example but not restricted to; newspapers, spouse/family meals, alcohol, TV rental, etc.); > Surgical, medical or dental appliances, other than surgical prostheses specified in the Sovereign benefit maximums listing, including but not limited to, cardiac pacemakers, nerve appliances, cochlear implants, bite splints and orthotics; > Any condition arising from participation in a criminal act; > Any condition specifically excluded by endorsement to the schedule ; > Costs incurred outside New Zealand (except where expressly covered under the Overseas Medical Treatment benefit in Section 2l); and > Palliative care. Sovereign will not pay any part of your claim that you can recover from sources outside your MajorCare policy, in particular under any other contract of insurance, whether you claim from these sources or not. 5. Multiple procedures Sovereign will not pay any MajorCare benefit for additional surgery that is performed during one operation, which is not directly related to the medical condition or treatment that is covered under the terms of this MajorCare policy. (For example but not limited to; abdominal scar revisions, pelvic floor repair when accompanying surgery for a hysterectomy.)
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126 MAJAP-TC version 8 Effective 5 December 2016
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