Charges, costs and fees that Sovereign has determined are reasonable for the treatment, procedure, consultation, test, diagnostic imaging, support or care when carried out or taking place in New Zealand (irrespective of whether the treatment, procedure, consultation, test, diagnostic imaging, support or care is in fact carried out or takes place in New Zealand or overseas). For further details about how these charges are calculated and how they impact on your claims see the section ‘Part D : How to make a claim’ on pages 4 – 6. A person who holds a current practicing certificate in compliance with the Health Practitioners Competence Assurance Act 2003 (or its successor) and is a member of the appropriate registration body, for example, the Medical Council of New Zealand, the Dental Council of New Zealand, the Pharmacy Council of New Zealand, or any successor organisations. A registered medical practitioner who is a member of an appropriately recognised specialist college and has authority granted under the Health Practitioners Competence Assurance Act 2003 (or its successor) to perform that health service and has Medical Council of New Zealand (or its succe ssor’s) vocational registration for that health service. A person who holds a current practicing certificate in compliance with the Health Practitioners Competence Assurance Act 2003 (or its successor) and is a member of the Nursing Council of New Zealand (or its successor). A subsequent surgery performed within 3 months of an initial surgery for the purpose of treating the same medical condition, where the life assured has had an accepted Surgery Benefit claim and paid any applicable excess . For example, if surgeries are staggered on the advice of an appropriate specialist for best medical practice.
reasonable charges
registered medical practitioner
registered medical specialist
registered nurse
related surgery
risk commencement date
The risk commencement date stated in the schedule.
The latest schedule issued by Sovereign to you which confirms the policy owner (s), the lives assured , important policy details about the policy and any specific endorsements or exclusions that Sovereign has applied to the policy and:
schedule
> any notice of a change to premiums ; and
any policy alteration or endorsement documents recording a change to the policy.
A set of criteria Sovereign uses to consider and approve chemotherapy or radiotherapy treatments under the Cancer Care benefit in order to ensure the treatment falls within reasonable charges . The criteria is determined by: > Whether the medicine is recommended for public funding by the Pharmaceutical Therapeutics Advisory Committee (or its successor);
Sovereign criteria
> The medical advice of the treating oncologists;
> International evidence of clinical effectiveness;
Other factors that Sovereign reasonably assesses as relevant.
Sovereign policies
Any policy or policies where Sovereign is the insurer.
transfer of ownership form
Sovereign’s standard form for an assignment of a policy by way of ordinary transfer.
Page 27 of 27
712 PH-UMB Version 9 Effective 8 April 2022
Powered by FlippingBook