Each person who is eligible for cover under this policy and is listed on the schedule as a life assured . The maximum amount Sovereign will pay for each benefit or combination of benefits, as specified for the benefit(s). A service or supply provided by a registered medical practitioner or registered medical specialist that Sovereign deems on reasonable grounds is necessary for the diagnosis, care or treatment of the disease or illness involved. Under no circumstances will the following services or supplies be considered medically necessary: > those services or supplies that do not require the skills or services of a registered medical practitioner or registered medical specialist ; > those services or supplies furnished mainly for the comfort or convenience of the life assured . > those services or supplies that do not relate to the medical treatment being provided (for example alcohol, toiletries, pay TV, car parking and take away meals).
life/lives assured
maximum cover
medically necessary
occupational therapy
Treatment provided by a registered occupational therapist who is:
in private practice and holds a current annual practicing certificate; and a member of the Occupational Therapy Board of New Zealand (or its successor).
An oral surgeon, oral medicine specialist or oral and maxillofacial surgeon registered with the Dental Council of New Zealand (or its successor) or a registered medical specialist vocationally registered in OralMaxillofacial surgery.
oral surgeon
pass back date
The date that the relevant change to Sovereign's Private Health policy comes into effect, as determined by Sovereign.
Treatment by a physiotherapist registered with the Physiotherapy Board of New Zealand (or its successor).
physiotherapy
policy fee
The administration fee portion of your premium .
policy owner(s)
The person(s) listed on the schedule as the Policy Owner(s).
The 12 month period from the risk commencement date through to (but excluding) the first anniversary date and each successive 12 month period from an anniversary date through to the next anniversary date .
policy year
premium(s)
The amount payable by you as consideration for this policy.
premium due date
The date on which a premium is payable under this policy, as agreed between you and Sovereign.
pre-existing condition
Any disease, injury or medical condition for which, prior to the risk commencement date , the life assured knew they had or ought on reasonable grounds to have known they had, or for which they had experienced a symptom, consulted a registered medical practitioner , received treatment or services from a registered medical practitioner or took prescribed drugs or medication.
prophylactic procedures
Procedures undertaken as preventative measures.
prostheses
The artificial parts used to replace body parts when specific types of surgery are undertaken.
public hospital
A “hospital care institution” as defined by s ection 58 of the Health and Disability Services (Safety) Act 2001 (or its amendment or replacement), that is directly or indirectly owned or funded by the New Zealand Government.
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712 PH-UMB Version 9 Effective 8 April 2022
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