> To allow for an unexpected increase in the type or level of claims that will not be sustainable long term based on the current schedule of premium rates or at any premium rates (uninsurable).
reimburse you for the remaining costs in accordance with this policy.
If you have two or more policies with Sovereign you cannot claim for, or be reimbursed for, an amount higher than the total cost of your treatment.
> To take account of a significantly escalated or new public health threat e.g. a pandemic.
Claims involving ACC
Sovereign will give you at least 30 days’ prior notice of any change to the terms of the policy (unless the changes are given effect as a result of the Guaranteed Enhancement Benefit). The notice will include an updated policy document and highlight any change to the premium and/or to your entitlements under it. You always retain the right to cancel this policy at any time.
This policy does not cover any costs arising from treatments or procedures for accidents or injuries including treatment injuries (medical misadventure) that ACC is legally responsible to pay. It is your responsibility to submit any accident related claim to ACC in the first instance. Where surgery is necessary, you must obtain prior approval from ACC before incurring private treatment costs. When ACC agrees to contribute to the life assured ’ s treatment costs, Sovereign may cover additional costs up to the reasonable charges or maximum cover of this policy. You must obtain Sovereign’s prior approval before incurring private treatment costs. If ACC declines the claim Sovereign reserves the right to require that the life assured applies to ACC for a review of that decision, before Sovereign has any obligation to consider a claim for treatment under this policy. If ACC upholds their decline decision Sovereign may cover your costs up to the reasonable charges or maximum cover of this policy. You must obtain Sovereign’s prior approval before incurring private treatment costs. Sovereign will not pay for any MRI or CT scans or other specialised imaging procedures recommended by a registered medical practitioner within seven days of an accidental injury claim being lodged with ACC . If ACC does not cover the claim due to the policy owner’s or the life assured ’ s failure to properly make a claim with ACC or comply with ACC’s claims requirements, we will deem this to mean that the policy owner or life assured has not made reasonable efforts to secure cover with ACC and so is not able to claim under this policy.
G. General terms and conditions Your obligations
You and every life assured agrees to:
> Provide complete and accurate information to Sovereign and comply with your duty of disclosure.
> Provide all information reasonably required by Sovereign in relation to the policy, any claims and the policy owner and/or life assured . > Attend, at Sovereign’s request, an examination or consultation with a registered medical practitioner or registered medical specialist of Sovereign’s choosing and at Sovereign’s cost. The registered medical practitioner or registered medical specialist will advise Sovereign of the results of the examination or consultation in order to assist Sovereign to determine the nature and extent of any medical condition and the cover available under the policy.
> Pay premiums as and when they fall due to ensure that the policy is not cancelled.
> Notify us as soon as possible of any change that might affect the policy. If in doubt, please call us to discuss.
> Notify us if you change your contact details. All notices from Sovereign to you will be deemed delivered if we have sent them to you using the contact details you last provided us with.
Subject to the laws of New Zealand
This policy is issued in New Zealand and is subject to the laws of New Zealand.
Claims on other insurers
No surrender value
It is your responsibility to advise Sovereign if there is another insurer, who is responsible under any contract of insurance or indemnity to pay for any costs for which you make a claim under this policy. You must make every reasonable effort to make a claim or seek recovery of costs from that insurer for any expenses recoverable. Any expenses covered by another insurer in this way will not be covered by Sovereign under this policy. However if there are other expenses that are not covered by your other insurer please send details of the level of payment to us along with your claim. We will deduct the payment made by your other insurer then
This policy does not participate in the profits of Sovereign. This policy has no surrender or cash value if it is cancelled.
Complaints
Your suggestions, compliments, queries and complaints are important to Sovereign, and help us to improve the service we provide to you. If you would like to make a complaint please send your complaint to Sovereign in writing or by email and we will investigate your complaint and respond to you.
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712 PH-UMB version 9 Effective 8 April 2022
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