Everyday Cover Policy document

Transcription

1 Everyday Cover Polcy document

2 Contents We re happy to help you stay healthy...3 Read ths polcy carefully 3 How to contact nb 4 What you agreed wth us when you appled for ths Everyday polcy...4 You agree that you have dsclosed what we need to know 4 You agree we wll communcate onlne 5 How we work together wth you under ths polcy...5 As your nsurer, these are our promses 5 We ask that you honour these promses to us 6 Ths polcy covers New Zealand resdents 6 You can nclude dependent chldren under age 18 on your polcy 6 You can make changes to your polcy...6 You can add people to ths polcy, or remove them 7 You can change the detals on the polcy 8 You can cancel the polcy or cover 9 When your cover starts...10 You wll have a watng perod before you can clam 10 Reasons we wll cancel your polcy 12 Makng a clam...13 Meetng the requrements of your polcy 13 When we can t pay clams 13 Supportng documents for clams 13 You must pay your premums on tme...14 Your premums are based on your benefts, and ncrease wth age 15 We may change premums and benefts f general crcumstances change 15 The health servces we cover...16 The benefts we cover Dental beneft 17 2 Optcal beneft 17 3 General Treatment beneft 17 4 GP and Pharmaceutcal Prescrpton beneft 17 5 Mental Health beneft 17 6 Speech Therapy beneft 17 7 Therapeutc Care beneft 17 8 Vaccnatons beneft 18 What we do not cover...18 Health servces we do not cover 18 Meanngs of medcal terms...20 Feedback and complants...23 Get n touch 23 Have you got a complant? Please let us know 23 Our prvacy polcy 23 2

3 We re happy to help you stay healthy Thank you for trustng nb to nsure your good health. You want to take care of yourself, and our Everyday Polcy s desgned to help. Read ths polcy carefully Ths polcy document explans how your polcy works, how to make a clam, what we do and do not cover, and your responsbltes. The documents that make up your Contract of Insurance Ths polcy document s one of a number of documents that together form your Contract of Insurance. These are (n descendng order f they say slghtly dfferent thngs): 1. the Acceptance Certfcate or Renewal Certfcate (whchever s most recent) 2. ths polcy document (or any subsequent documents that replace ths document) 3. any applcatons completed by the polcyowner and all the nsured persons covered under the polcy. Read the nformaton carefully so that you know what you are covered for, what you need to tell us, how to make a clam and the other terms and condtons of your polcy. Acceptance Certfcate The most recent document ttled Acceptance Certfcate sent to the polcyowner by nb as part of the Contract of Insurance. Renewal Certfcate The most recent document enttled Renewal Certfcate that we send to the polcyowner as part of the Contract of Insurance. Helpful hnts for understandng your polcy Always check wth us before you have any health servce Unless specfed, ths polcy document only descrbes the terms and condtons of the nb Everyday polcy that apply when the document was ssued. How your Everyday polcy usually works Here s a quck overvew of how your polcy works. To understand your polcy completely, read ths document and the other documents n your Contract of Insurance. 1. You see a recognsed health professonal for your treatment. They refer you for a health servce, or perform t themselves. 2. You make a clam 3. We pay the clam, up to the lmt of the beneft for that health servce. Words wth specal meanngs n ths polcy Some words n ths document have a specfc meanng whch apples to your nb Everyday polcy only. Meanngs of nsurance terms we use frequently are lsted below. Meanngs of less common nsurance terms are explaned on the page they appear. Medcal terms are prnted n talcs, and are defned n Meanngs of medcal terms on page 20. Meanngs of nsurance terms Renewal Certfcate The most recent document enttled Renewal Certfcate that we send to the polcyowner as part of the Contract of Insurance. Beneft or benefts An amount of money payable from nb ether to, or on behalf of, an nsured person, for approved expenses for ther health servce n accordance wth ther Contract of Insurance. Beneft lmt or beneft lmts The maxmum amount nb wll pay for each beneft for each nsured person every polcy year. 3

4 Clam or Clams or Clamng A request from an nsured person for payment of benefts, or a confrmaton of future payment of benefts, whch comples wth ths polcy document. Cover or covers The defned group of benefts we can pay to an nsured person under ther chosen level of health nsurance whch comply wth the polcy document. Insured person or nsured persons or person nsured Anyone named as an nsured person on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Ths may nclude the polcyowner. nb, us, our, we nb nz lmted Polcy or polces Ths contractual agreement between the polcyowner and nb as governed by the Contract of Insurance. Polcyowner A person who admnsters the polcy and whose name s lsted on the Acceptance Certfcate or Renewal Certfcate whchever s most recent as polcyowner(s). Ths means all polcyowners f there s more than one. Premum The amount of money the polcyowner needs to pay us for a specfed perod of cover for the polcy. You or your Anyone named as an nsured person on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Ths may nclude the polcyowner. Headngs don t form part of the cover The headngs n ths document are for your gudance only these don t form part of your cover. How to contact nb The my nb portal provdes 24 hour access to your polcy and clams detals go to nb.co.nz/portal. Emal us for general enqures at contactus@nb.co.nz Emal us for clams at clams@nb.co.nz How to get fnancal statements You can get a copy of nb nz lmted s fnancal statements for the last reported fnancal year. Emal us at contactus@nb.co.nz. What you agreed wth us when you appled for ths Everyday polcy You agree that you have dsclosed what we need to know All the nformaton that the polcyowner and all nsured persons, or anyone on ther behalf, have gven us must be correct and complete. You have a legal duty of dsclosure you must tell us everythng you knew, or should have known, whch would have nfluenced a prudent nsurer s decson to accept your applcaton, and on what terms. Anyone nsured under ths polcy must have told us about any changes to the nformaton they gave us before any commencement date, effectve date or jon date of ths polcy whchever apples. Otherwse, we can cancel ths polcy retrospectvely from the commencement date, effectve date or jon date whchever apples and not pay any clams after those dates. We may keep all the premums pad. And we may recover any clams we have pad from the polcyowner or the nsured person. 4

5 Commencement date The start date of your polcy that s shown as the orgnal polcy commencement date on the Acceptance Certfcate, or Renewal Certfcate whchever s most recent. Effectve date The date any changes made to the polcy take effect. The date s shown as Effectve date on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Jon date The date when cover starts for an nsured person. Ths date s shown on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. You agree we wll communcate onlne The polcyowner and nsured people must gve us vald emal addresses and always tell us mmedately when addresses change. Wherever ths polcy refers to a notce n wrtng such as a certfcate, we mean a wrtten notce sent electroncally. You agree to recevng and sendng documents onlne We wll send you all communcatons about ths polcy electroncally through emal or through my nb. We wll send communcatons to the emal address that the polcyowner gves us when they apply, or when they tell us t has changed. That emal address wll be our frst pont of contact. Informaton we wll send onlne ncludes polcy documents and notces. You agree to send us all communcatons about ths polcy through emal or through the my nb portal, nb.co.nz/portal. How we work together wth you under ths polcy As your nsurer, these are our promses We wll value you as customers We wll: deal wth feedback and complants quckly and responsbly make every possble effort to resolve complants to the polcyowner s and the relevant nsured person s satsfacton, whenever we can provde a 14-day free-look perod on all health cover sales, as long as you have made no clams durng that tme. We wll keep you nformed We wll: answer your questons promptly and accurately at the frst pont of contact, whenever we can gve you detaled health polcy nformaton and help you understand what you are covered for. We wll handle transactons smoothly We wll: keep you nformed about the process of your clam whenever we can gve at least 30 days wrtten notfcaton of any changes to cover or premum ncreases meet the terms of our drect debt authorty. We wll respect your prvacy We wll: treat your personal nformaton wth respect and n total accordance wth the Prvacy Act 1993 and Health Informaton Prvacy Code

6 We ask that you honour these promses to us Please comply wth ths polcy n full We ask you to: be accurate and truthful n your health nsurance applcaton and clams (see You agree that you have dsclosed what we need to know on page 4) understand watng perods, so you know when you can start clamng f you are unsure, just ask us. Please keep us nformed We ask you to: provde all nformaton that we reasonably requre that s relevant to the polcy keep your premums up to date to ensure you reman covered meet the terms outlned n our drect debt authorty tell us as soon as you can of any change that may affect your polcy, and f unsure just ask us. Ths polcy covers New Zealand resdents Ths polcy covers anyone who legally lves n New Zealand. We may ask to see orgnals or certfed copes of all the nsured persons relevant documents. If an nsured person no longer meets the crtera, we may cancel ther cover. You can nclude dependent chldren under age 18 on your polcy A dependent chld under age 18 must be accompaned on the polcy by at least one adult aged 18 or older who s the polcyowner. Ths can be the chld s parent or legal guardan. Unless otherwse approved by us, a person under age 18 years s not elgble to be a polcyowner. A dependent chld wll be charged adult premum rates on the polcy annversary date after they reach age 21. We wll automatcally contnue to cover them on ths polcy as an adult nsured person. We wll deduct the addtonal premum for the cover, from the same payment source and at the same frequency as ths polcy, unless you tell us otherwse. Dependent chld An nsured person s natural or legally adopted chld under 21 years of age. Polcy annversary date The date 12 months after the commencement date and every 12-month annversary of that date. You can make changes to your polcy The polcyowner can vew and change the polcy The polcyowner s the prmary account holder. They have the full authorty to make changes to the polcy and make clams enqures about anyone on the polcy. If the polcy has more than one polcyowner, all must consent to any changes. Unless we specfy, polcyowners can make changes at a polcy annversary date. If you seek a change at a dfferent tme, we wll make the change n algnment wth your next bllng cycle. The polcyowner must gve us at least 30 days notce n wrtng, by emal, before they want the change to take effect. If the change results n a change of premum, we wll adjust t from the next bllng date. Polcy annversary date The date 12 months after the commencement date and every 12-month annversary of that date. 6

7 You can add people to ths polcy, or remove them You can add a partner, dependent chld, parent or grandchld The polcyowner can add a partner, dependent chld, parent or grandchld onto ther polcy at any tme. The nsured person must meet the elgblty crtera (see Ths polcy covers New Zealand resdents on page 6). The nsured person (or ther parent or legal guardan f they are under age 18) must agree about the addton to the polcy. The polcyowner and anyone to be added must follow our applcaton process. Cover for the new nsured person wll start: from the effectve date or jon date whchever apples shown on your Acceptance Certfcate or Renewal Certfcate (whchever s most recent.) after any applcable watng perod. We wll charge an addtonal premum for each nsured person added. Partner An nsured person s spouse or a person who lves wth the nsured person n a martal, de-facto or cvl unon relatonshp. Dependent chld An nsured person s natural or legally adopted chld under 21 years of age. Effectve date The date any changes made to the polcy take effect. The date s shown as Effectve date on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Jon date The date when cover starts for an nsured person. Ths date s shown on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Acceptance Certfcate The most recent document ttled Acceptance Certfcate sent to the polcyowner by nb as part of the Contract of Insurance. (Also see Renewal Certfcate.) Renewal Certfcate The most recent document enttled Renewal Certfcate that we send to the polcyowner as part of the Contract of Insurance. We send you a renewal certfcate each year, at least 30 days before your polcy annversary date. Watng perod A perod of tme after the commencement date, effectve date or the jon date, durng whch we won t pay a clam for that specfc beneft. You can remove an nsured person An nsured person can be removed from ths polcy: f they make a wrtten request or f the polcyowner makes a wrtten request. A person removed from the polcy can contnue nsurance wth us. Watng perods apply f a person moves to a new polcy If an nsured person needs to transfer to a new polcy wth the same level of cover, a watng perod may apply before they can make a clam. Any watng perod apples from the commencement date, effectve date or jon date of the orgnal polcy whchever date apples. Turn to page 11 for a lst of watng perods for ths polcy s benefts. 7

8 Commencement date The start date of your polcy that s shown as the orgnal polcy commencement date on the Acceptance Certfcate, or Renewal Certfcate whchever s most recent. Effectve date The date any changes made to the polcy take effect. The date s shown as Effectve date on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Jon date The date when cover starts for an nsured person. Ths date s shown on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Acceptance Certfcate The most recent document ttled Acceptance Certfcate sent to the polcyowner by nb as part of the Contract of Insurance. (Also see Renewal Certfcate.) Renewal Certfcate The most recent document enttled Renewal Certfcate that we send to the polcyowner as part of the Contract of Insurance. We send you a renewal certfcate each year, at least 30 days before your polcy annversary date. Watng perod A perod of tme after the commencement date, effectve date or the jon date, durng whch we won t pay a clam for that specfc beneft. You can change the detals on the polcy You can add or remove a Hosptal cover The polcyowner can add Standard Hosptal or Premum Hosptal to ths polcy at any tme n the polcy year for an addtonal premum, by makng an applcaton. The added Hosptal cover wll start from the effectve date or jon date whchever apples shown on the Acceptance Certfcate or the Renewal Certfcate (whchever s most recent). And the polcyowner can remove an nb Hosptal cover at a polcy annversary date. We need you to gve us 30 days notce before we apply the change. Effectve date The date any changes made to the polcy take effect. The date s shown as Effectve date on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Jon date The date when cover starts for an nsured person. Ths date s shown on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Acceptance Certfcate The most recent document ttled Acceptance Certfcate sent to the polcyowner by nb as part of the Contract of Insurance. (Also see Renewal Certfcate.) Renewal Certfcate The most recent document enttled Renewal Certfcate that we send to the polcyowner as part of the Contract of Insurance. We send you a renewal certfcate each year, at least 30 days before your polcy annversary date. Polcy annversary date The date 12 months after the commencement date and every 12-month annversary of that date. Once we have accepted the changes, we wll send the polcyowner a new Acceptance Certfcate or Renewal Certfcate whchever s most recent that wll show the changes. 8

9 Acceptance Certfcate The most recent document ttled Acceptance Certfcate sent to the polcyowner by nb as part of the Contract of Insurance. (Also see Renewal Certfcate.) Renewal Certfcate The most recent document enttled Renewal Certfcate that we send to the polcyowner as part of the Contract of Insurance. We send you a renewal certfcate each year, at least 30 days before your polcy annversary date. You can cancel the polcy or cover As the polcyowner you can cancel the polcy or cover for an nsured person unless we permt t wthout your authorsaton. You must tell us n wrtng. You must gve us at least 30 days notce of the cancellaton. 9

10 When your cover starts Your cover starts from the commencement date, effectve date or jon date whchever apples shown on your Acceptance Certfcate or Renewal Certfcate (whchever s most recent). You wll have a watng perod before we accept clams and pay benefts. Commencement date The start date of your polcy that s shown as the orgnal polcy commencement date on the Acceptance Certfcate, or Renewal Certfcate whchever s most recent. Effectve date The date any changes made to the polcy take effect. The date s shown as Effectve date on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Jon date The date when cover starts for an nsured person. Ths date s shown on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Acceptance Certfcate The most recent document ttled Acceptance Certfcate sent to the polcyowner by nb as part of the Contract of Insurance. (Also see Renewal Certfcate). Renewal Certfcate The most recent document enttled Renewal Certfcate that we send to the polcyowner as part of the Contract of Insurance. We send t to renew your polcy once a year, at least 30 days before your polcy annversary date. Watng perod A perod of tme after the commencement date, effectve date or the jon date, durng whch we won t pay a clam for that specfc beneft. You wll have a watng perod before you can clam You can clam for the benefts provded by the cover once any watng perods are over, provded that your premums are pad up to date. The watng perods below apply for each nsured person for the Everyday polces. The watng perod starts at the commencement date, effectve date or jon date whchever apples. 10

11 Beneft for treatment Dental beneft Preventatve dental treatment General dental treatment Dental beneft Major dental treatment Orthodontc treatment GP Treatment and Pharmaceutcal Prescrptons beneft GP consultaton Pharmaceutcal prescrpton Mental Health beneft Psychology and psychatry consultatons General Treatment beneft Physotherapy Chropractc treatment Osteopathc treatment Optcal beneft Optcal applances (such as spectacles and contact lenses) Optcal examnatons Speech Therapy beneft Speech therapy Therapeutc Care beneft Acupuncture Tradtonal Chnese medcne Remedal massage Vaccnatons beneft Vaccnatons Watng perod 2 months 12 months 2 months 6 months 2 months 6 months 2 months 2 months Watng perods may apply f you change your nb Everyday cover You can change your nb Everyday cover at polcy annversary. The applcaton must be made by the polcyowner. We may not accept your applcaton. But f we do, your new cover wll start as soon as your applcaton s accepted. If you change your cover to a polcy that offers a hgher level of benefts, you may have to serve further watng perods. But f you change to a polcy wth comparable cover, we recognse watng perods that you have already served. Check wth us to fnd out whch covers are comparable. If you change your nb Everyday cover, these watng perod rules apply: If Then Your cover has hgher or new benefts Watng perods wll apply from the effectve date. They wll nclude any watng perod you have already served under the prevous cover. There s no change n your cover s benefts There s no change n your watng perods they apply as before the change, from the commencement date, effectve date or jon date. Your cover provdes lower or fewer benefts The watng perod apples from the commencement date or jon date whchever apples from before the change n cover 11

12 Watng perod A perod of tme after the commencement date, effectve date or the jon date, durng whch we won t pay a clam for that specfc beneft. Commencement date The start date of your polcy that s shown as the orgnal polcy commencement date on the Acceptance Certfcate, or Renewal Certfcate whchever s most recent. Effectve date The date any changes made to the polcy take effect. The date s shown as Effectve date on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Jon date The date when cover starts for an nsured person. Ths date s shown on the Acceptance Certfcate or Renewal Certfcate whchever s most recent. Polcy annversary date The date 12 months after the commencement date and every 12-month annversary of that date. To avod new watng perods, mantan contnuous cover You must mantan contnuous cover wth nb to: ensure you can contnue to clam benefts avod havng to re-assess all the nsured persons health avod havng to serve the watng perods agan f anyone on your polcy decdes to re-jon later. If you don t mantan contnuous cover, you may lose advantages lke dscounts and concessons. When you resume cover, check your Acceptance Certfcate or Renewal Certfcate whchever apples. Watng perod A perod of tme after the commencement date, effectve date or the jon date, durng whch we won t pay a clam for that specfc beneft. Acceptance Certfcate The most recent document ttled Acceptance Certfcate sent to the polcyowner by nb as part of the Contract of Insurance. (Also see Renewal Certfcate). Renewal Certfcate The most recent document enttled Renewal Certfcate that we send to the polcyowner as part of the Contract of Insurance. We send t to renew your polcy once a year, at least 30 days before your polcy annversary date. Reasons we wll cancel your polcy We have the rght to cancel the polcy or cover for an nsured person, f: The polcy ends The premums are unpad more than 90 days after the due date then none of the nsured persons wll be able to clam. An nsured person becomes nelgble An nsured person s no longer a New Zealand resdent. The last nsured person covered by ths polcy des. You breach the terms of the polcy Any nsured person breaches the terms of the polcy. Any nformaton provded by, or on behalf of, the polcyowner or any nsured person s not true, correct and complete. An nsured person has acheved, or tred to acheve an advantage, fnancal or not, for themselves or for anyone else on the polcy, that they are not enttled to under ths polcy. 12

13 An nsured person has behaved offensvely to or ntmdated nb employees. If we cancel ths polcy or cover for an nsured person, we may keep any premums you have pad. And f we have pad any clams, we may requre you to pay them back to us. Makng a clam You have two ways to make a clam. Always quote your polcy number. You can make a clam onlne 1. Vst the my nb portal at nb.co.nz/portal 2. Upload a photo of your recept or nvoce usng the nb app. Meetng the requrements of your polcy All clams must meet the requrements of your Contract of Insurance, and What we do not cover on page 18. You must gve us all relevant nformaton wth the clam (see Supportng documents for clams on page 13). The clam must relate to an nsured person. We wll only pay the clam to a recognsed provder, polcyowner or nsured person, even f someone else has pad the account or bll. Contract of Insurance means the followng documents together: the Acceptance Certfcate or Renewal Certfcate that we send you n subsequent years whchever s most recent ths polcy document (or any subsequent document that replaces t) any applcatons that have been made by the polcyowner or nsured person to jon the polcy. If there are dfferences, the documents apply n descendng order. When we can t pay clams When your premums are not up to date. If your premum s not up to date on the day we accept a clam, we wll not pay untl you have pad your premum n full. If you have made a clam and then fall behnd wth your premums, we may decde not to cover your clam. You can only clam for health servces carred out by recognsed provders. We have the rght to recover any money that we pay by mstake, or you obtan by fraud. We also have the rght to recover money you obtan by contravenng the polcy or breakng the law. Submt your clam wthn a year We recommend that you send us all clams wthn 12 months of havng the health servce. We don t adjust clams payments for nflaton. Supportng documents for clams Supportng documents for clams must be: n a format approved by nb supported by recognsed health professonal s nvoces or temsed recepts on ther letterhead; the paperwork must show ther offcal stamp and GST number. If we need more nformaton to assess your clam, you must follow our requests. Who we pay Your clam must relate to a person who s nsured on ths polcy. Everyone covered by ths polcy must comply wth t before we wll pay any clam. We remburse a recognsed provder, polcyowner, or nsured person, regardless of who pad the bll. 13

14 If we are refundng you by drect credt, please make sure your bankng detals are correct. If we pay to the wrong account because of your error, we can t make a replacement payment untl the orgnal payment s returned to us. We wll only refund to a nomnated New Zealand bank account n New Zealand dollars. Where possble, we process clams wthn 5 workng days Where possble, we wll process your request for clam wthn fve workng days of recevng t, unless we need more nformaton. You cover any costs for submttng a clam If you need help to complete the clam, or we ask for a medcal report, you need to pay any cost for provdng them. If we ask for more nformaton to assess the clam, we wll pay to get t. You must pay your premums on tme You must keep your premums up to date to keep the polcy actve. Otherwse, nsured persons on the polcy may not be able to clam benefts. If the premum rate changes durng the polcy year, we wll apply the change at your next polcy annversary date. You can pay your premums n advance for a maxmum of 12 months. Polcy year The 12-month perod that begns on the commencement date and ends at 6am on the polcy annversary date and each followng 12-month perod from one polcy annversary date to the next. Polcy annversary date The date 12 months after the commencement date and every 12-month annversary of that date. Your payment optons depend on payment frequency Your payment optons are below. You must pay n advance, unless we have specfcally told you otherwse: Drect debt If you pay your premums by drect debt from a bank, buldng socety, or credt unon account, you can pay weekly, fortnghtly, monthly, quarterly, half yearly or yearly. Credt card If you pay your premums by credt card payment from a MasterCard or Vsa, you can pay monthly, quarterly, half yearly or yearly. Our agreement wth you We wll gve the polcyowner at least 30 days notce n wrtng f the amount of the drect debt s ncreased as a result of a premum rate change. We wll keep any nformaton about the nomnated account confdental, except when we need to complete drect debts wth the fnancal nsttuton. When the due date s not a workng day, we wll debt the account on the frst workng day after the due date. We have the rght to cancel drect debt arrangements f the fnancal nsttuton dshonours drect debts. We wll arrange a dfferent payment method wth the polcyowner. The detals of the drect debt arrangement are contaned n the drect debt authorty form whch the polcyowner completes. We wll rely on those detals to process payments untl told otherwse. Your agreement wth us It s the polcyowner s responsblty to: make sure the nomnated account can allow drect debt make sure there are enough funds avalable n the account to make a payment on the due date 14

15 tell us f the account detals change, or f the account s transferred or closed arrange a dfferent payment method f we cancel the drect debt arrangements ensure all authorsed people of the nomnated account sgn the drect debt authorty form update us f the credt card detals change You can change the drect debt arrangements The polcyowner may cancel or stop a drect debt wth ther fnancal nsttuton. They must gve nstructons n wrtng. The polcyowner can change the drect debt arrangements n lne wth the terms and condtons of our drect debt authorty, at least 10 calendar days before the next due date. Contact us f you have an enqury or problem about drect debts If the polcyowner has a drect debt enqury, or beleves a debt has been made ncorrectly, let us know us mmedately. Emal us at contactus@nb.co.nz If we can t reach you, we wll contnue your cover by makng deductons We want to ensure your valuable cover contnues, f a premum deducton advce s returned to us as gone / no address. We wll contnue to make premum deductons untl the polcyowner tells us to stop the deductons. Your premums are based on your benefts, and ncrease wth age Your premums are calculated accordng to the rates that apply from tme to tme for the polcy selected. Premums automatcally ncrease when an nsured person reaches a specfed age. The same changes to the premum rates and age-related steps apply to everyone nsured under ths polcy. We may change premums and benefts f general crcumstances change We wll make no changes to your ndvdual polcy alone, regardless of your clams hstory. However, dependng on wder crcumstances we may change the: premum rates (ncludng age related steps) benefts terms of cover (ncludng What s not covered and words defned n ths polcy) durng the lfe of the polcy. We wll only make changes n the crcumstances below, and only to compensate for the partcular crcumstances that apply. The law that apples to the polcy changes (ncludng tax changes). Our costs ncrease as a result of medcal nflaton as we determne. To ncrease the level of cover under a beneft or to add a new beneft. To allow for an unexpected and sgnfcant ncrease n the type or level of clams under the polcy, whch are unsustanable long term and threaten ts commercal vablty. To algn ths polcy wth a newer verson of the same type of polcy we offer later, wth smlar premums or benefts. To take nto account unexpected, severe publc health threats, such as a pandemc. We wll let you know when premums ncrease We wll gve the polcyowner 30 days wrtten notce of any change n premums. The polcyowner has the rght to cancel ths polcy at any tme. 15

16 The health servces we cover Your Everyday cover does not cover any hosptal related servces. It provdes cover for the health servces and treatments below. If we accept your clam, we remburse: 60% of the health servce or treatment cost for Standard Everyday cover 80% of the health servce or treatment cost for Premum Everyday cover for each cost you ncur, up to the annual beneft lmt. Watng perods apply to specfc benefts (see page 11). The beneft lmts for Standard Everyday and Premum Everyday are below. Beneft lmt or beneft lmts The maxmum amount nb wll pay for each beneft for each nsured person every polcy year. Beneft Treatment Dental beneft Preventatve dental treatment General dental treatment Major dental treatment Orthodontc treatment GP and Pharmaceutcal Prescrptons beneft GP consultatons Pharmaceutcal prescrptons General Treatment beneft Physotherapy Chropractc treatment Osteopathc treatment Mental Health beneft Psychology and psychatry consultatons Optcal beneft Optcal applances (such as spectacles and contact lenses) Optcal examnatons Speech Therapy beneft Speech therapy Therapeutc Care beneft Acupuncture Tradtonal Chnese medcne Remedal massage Vaccnatons beneft Vaccnatons Annual beneft lmt Standard Everyday Premum Everyday $750 $1,000 $350 $500 $350 $500 $350 $500 $350 $500 $200 $400 $150 $300 16

17 The benefts we cover 1 Dental beneft Ths beneft covers the cost of: Preventatve dental treatments ncludng examnatons, cleanng and scalng General dental treatments ncludng fllngs, basc extractons and assocated x-rays Major dental treatments ncludng root canal therapy, removal of wsdom teeth, crowns, brdges, endodontc treatment and dentures Orthodontc treatments performed by a regstered dental practtoner, orthodontst or oral surgeon We do not cover: Treatments covered under the school dental servce or general dental beneft scheme Any addtonal costs of gold or other materals that are unnecessarly expensve or not normally used n dental treatments Treatment that s purely cosmetc 2 Optcal beneft Ths beneft covers the cost of: Optometrst, orthoptst and optcan examnaton fees Prescrpton spectacles and contact lenses We do not cover: Replacng a lens as part of the process of reparng spectacles Sunglass tntng, coatng or hardenng lenses. 3 General Treatment beneft Ths beneft covers the cost of physotherapy, chropractc and osteopathc consultatons and treatment. 4 GP and Pharmaceutcal Prescrpton beneft Ths beneft covers the cost of GP consultaton and pharmaceutcal prescrptons. We do not cover: Any addtonal servces performed n the GP s rooms, such as mnor surgery Cryotherapy, pulse lght therapy, photodynamc therapy or njectons of any knd Any drugs not lsted on the PHARMAC pharmaceutcal schedule Drugs lsted under Secton H of the PHARMAC pharmaceutcal schedule 5 Mental Health beneft Ths beneft covers the cost of consultatons by a psychatrst or psychologst. 6 Speech Therapy beneft Ths beneft covers the cost of speech therapy wth a recognsed health professonal. 7 Therapeutc Care beneft Ths beneft covers the cost of: Acupuncture Tradtonal Chnese Medcne Remedal massage 17

18 We do not cover: We do not pay for addtons to the treatment tself. Examples nclude books, DVDs, CDS, assocated dagnostcs, testng (such as Vegatestng), and reports. 8 Vaccnatons beneft Ths beneft covers the cost of vaccnatons, admnstered by a recognsed health professonal. We do not cover: Government funded, expermental or non-pharmac approved vaccnatons. What we do not cover We do not cover the health servces, treatments and costs lsted n ths secton. Health servces we do not cover We do not pay benefts for any of the followng health servces that relate to or result from any of the condtons or stuatons below. All examples are ndcatve only and are not an exhaustve lst of what s excluded Coverage relatng to your polcy or clam Clams f you ve gven us false or naccurate nformaton when you made your clam or appled for your polcy Health servces not mentoned n ths polcy document Provders who do not meet our crtera Health servces you get after you have reached your polcy beneft lmt Health servces you get durng a watng perod, between takng out a polcy wth us, and the date you can start clamng Incomplete clams Clams that do not meet the terms of ths polcy. Servces provded by others Health servces provded by health professonals who are not recognsed by the Medcal Councl of New Zealand (apart from those lsted n ths polcy document) Products, substances or servces recognsed under New Zealand legslaton as llegal. Servces provded by a famly member, such as accommodaton, travel, or health servces Expenses you could recover from a thrd party, such as another person, a company or an nsurer Costs you that result from admsson to a publc hosptal or a recognsed prvate hosptal these may be covered under an nb Hosptal polcy Servces outsde New Zealand Health servces you ve receved outsde New Zealand Items you have bought outsde New Zealand, such as tems you ordered on the nternet from another country Acute medcal condtons and observaton Symptoms or condtons that need hosptal admsson for treatment or montorng ether mmedately or wthn 48 hours Immune defcency dsease HIV and AIDS Electve treatment Vson enhancement, such as for myopa, hypermetropa, presbyopa, astgmatsm, treatments such as radal keratotomy and photorefractve keratectomy Breast reconstructon or reducton, gynaecomasta, and revson of breast mplants, unless we approve the treatment Cosmetc reconstructons, reductons, weght loss 18

19 Treatment for obesty, such as gastrc bandng, sleeve, and bypass Gynaecomasta, breast reducton, blepharoplasty, unless we approve Treatment of sleep problems and dsorders, such as snorng, nsomna and sleep apnoea Treatment of allerges and allergc dsorders, such as allergy testng and desenstsaton Screenng where there s no sgn or symptom of a condton Preventatve treatment n the absence of sgns or symptoms of an llness, dsease or medcal condton Genetc testng for any purpose Fertlty treatment Famly plannng, such as nfertlty, termnaton of pregnancy, reversal of sterlsaton, contracepton, caesarean secton, hormone replacement therapy and erectle dysfuncton Condtons that run n famles Any congental, heredtary or genetc condton, such as a brth dsorder, chromosomal dsorder, famlal predsposton, or famlal rsk Mental and psychatrc condtons (except where the contrary s expressly specfed n the polcy) Psychatrc, behavoural, psychologcal or developmental condtons, such as depresson, ADD, ADHD or eatng dsorders Substance msuse such as msuse of alcohol or drugs Self-nflcted njures Contnuous care such as geratrc care, pallatve care, respte care, long-term care, convalescence and dsablty care, costs for support servces costs, f for example you become senle or develop dementa Crme, rot, and war Anythng you do or don t do as a result of any medcal condton, that results n your beng charged under the Crmes Act Cover for care durng a war or rot Consultatons we don t cover If an nsured person sees the same recognsed provder twce on the same day, we wll only pay the costs for the frst vst Consultatons that do not take place face-to-face such as over the phone or on Skype Admnstraton and prescrpton charges Admnstraton costs such as fax charges, after hours costs, overtme, cancellaton charges and prortsaton fees Prescrpton charges (except where the polcy specfcally covers them). 19

20 Meanngs of medcal terms Acupuncture Treatment provded by an acupuncturst who s recognsed as such at nb s sole dscreton. Acute medcal condton A sgn, symptom or condton that needs hosptal admsson for treatment or montorng, mmedately or wthn 48 hours. Admsson To have followed an admnstraton process to become an admtted patent as a prvate patent n a recognsed prvate hosptal. The admsson must be for treatment of a sgn, symptom or condton. Treatment n the emergency room of a recognsed prvate hosptal s not covered as an admsson. Chropractc Treatment Treatment provded by a chropractor. Chropractor A recognsed health professonal who s: n prvate practce and holds a current annual practsng certfcate, and a member of The Chropractc Board of New Zealand (or ts replacement, f the legslaton changes.) Condton Any llness, njury, alment, dsease, sckness, dsorder or dsablty. Congental A health anomaly or defect whch s present at brth whether t s recognsed or not, and whether t s nherted or caused external or envronmental factors such as drugs or alcohol. Consultaton A necessary face- to-face meetng wth a recognsed health professonal. The purpose must be to evaluate the medcal case and any treatment. A consultaton does not nclude the treatment tself. Ths does not nclude any vrtual consultatons, such as by phone or Skype. Dental practtoner A recognsed health professonal who s: n prvate practce and holds a current annual practsng certfcate a member of the Dental Councl of New Zealand (or ts replacement, f the law changes). Dental Treatment Treatment provded by a dental practtoner. Dagnostc nvestgaton An nvestgatve procedure to determne the presence or cause of a sgn, symptom or condton. For the purpose of ths cover, ths does not nclude skn bopses or treatment of any knd ncludng, pan relef. GP A recognsed health professonal who s: n prvate practce and holds a current annual practsng certfcate, and a member of the Medcal Councl of New Zealand (or ts replacement, f the legslaton changes). Health servce or Health servces Consultaton, assessment, dagnostc nvestgaton or treatment of a sgn, symptom or condton provded by a recognsed health professonal. 20

21 Obesty The World Health Organsaton recognsed defnton of obesty. Optcal applance Spectacles or contact lenses that correct sght and: are prescrbed by an optometrst or ophthalmologst are approved by nb Optometrst or optcan A recognsed health professonal who s: n prvate practce and holds a current annual practsng certfcate a member of the Optometrsts and Dspensng Optons Board of New Zealand (or an organsaton that replaces t). Orthodontst A recognsed health professonal who s: n prvate practce and holds a current annual practsng certfcate a member of the Dental Councl of New Zealand (or an organsaton that replaces t). Orthoptst A recognsed medcal professonal who s: n prvate practce and holds a current annual practsng certfcate a member of the New Zealand Orthoptc Socety (or an organsaton that replaces t). Osteopath A recognsed health professonal who s: n prvate practce and holds a current annual practsng certfcate, and a member of the Osteopathc Councl of New Zealand (or ts replacement f the legslaton changes). Osteopathc The treatment provded by a regstered osteopath. Pharmaceutcal prescrpton A legally wrtten order from a regstered specalst, GP, dentst or nurse practtoner to prepare and admnster a medcne. The medcne must be lsted under sectons A to G of the PHARMAC schedule (or ts replacement f the law changes). A regstered pharmacy must dspense the medcne. Physotherapst A recognsed health professonal who s: n prvate practce and holds a current annual practcng certfcate, and a member of The Physotherapy Board of New Zealand (or ts replacement, f the legslaton changes). Physotherapy Treatment provded by a physotherapst. Prvate practce A practce recognsed by nb (whether sole, partnershp or group) whch receves ts man ncome from the fees t charges to ts patents, wthout subsdy or fundng from the publc health sector. Psychatrst a recognsed health professonal who s: n prvate practce and holds a current annual practsng certfcate; 21

22 a member of the Royal Australan and New Zealand College of Psychatrst (or ts successor) and has Medcal Councl of New Zealand vocatonal regstraton n psychatry. Psychologst A recognsed health professonal who s n prvate practce and holds a current annual practcng certfcate; and a member of The New Zealand College of Clncal Psychology (or ts successor). Publc Hosptal A Hosptal owned and admnstered by the publcly funded health sector of the New Zealand Government. Recognsed health professonal A person who s: regstered and holds a current practsng certfcate that comples wth the Health Practtoners Competence Assurance Act 2003 (or ts replacement f the legslaton changes) a member of the approprate regstraton body, for example Medcal Councl of New Zealand, Dental Councl of New Zealand, the Nursng Councl of New Zealand or the Chropractc Board n New Zealand recognsed by nb. Recognsed provder A recognsed health professonal, recognsed prvate hosptal or other medcal faclty that s recognsed by nb. Regstered specalst A recognsed health professonal who: s n prvate practce and holds a current annual practsng certfcate s a member of an approprately recognsed specalst college has vocatonal regstraton n that specalty wth the Medcal Councl of New Zealand (or ts replacement, f the legslaton changes.). Ths defnton does not nclude those holdng vocatonal regstraton for accdent and medcal practce, emergency medcne, famly plannng, sexual health and reproductve health, general practce, medcal admnstraton, publc health medcne, or sports medcne. Remedal massage Treatment provded by a massage therapst who s recognsed as such at nb s sole dscreton. Screenng An nvestgaton carred out n the absence of any sgn or symptom of a condton for example, testng due to a famly hstory of cancer. Speech therapy Treatment that s provded by a recognsed health professonal who s: n prvate practce and holds a current annual practsng certfcate, and a member of the New Zealand Speech Language Therapsts Assocaton (or ts replacement, f the legslaton changes). Surgery or surgcal An operaton performed n a recognsed provder under an anaesthetc (general, ntravenous sedaton, local or spnal) requrng a surgcal ncson to remove or repar damaged or dseased tssue. For the purpose of ths cover, ths does not nclude njectons of any type. Tradtonal Chnese Medcne Consultatons and treatment provded by a tradtonal Chnese medcne practtoner who s recognsed as such at nb s sole dscreton Treatment A health servce that nvolves medcal care, therapy, or surgery. 22

23 Feedback and complants Any questons? More nformaton? Your customer feedback helps to mprove the qualty of our servce. Get n touch Go to nb.co.nz Emal contactus@nb.co.nz Have you got a complant? Please let us know We have a process for makng sure complants are heard and dealt wth. You are welcome to talk to the person who handled your enqury or clam. Or to talk to a senor team member or team leader. nb Complants Commttee Or you can wrte to the nb Complants Commttee: Emal complants@nb.co.nz We wll do everythng we can to resolve complants to your satsfacton. If you are not satsfed wth the outcome, we wll wrte a letter of deadlock whch gves you the opton to take your complant to the Insurance & Fnancal Servces Ombudsman (IFSO): The Insurance & Fnancal Servces Ombudsman PO Box Wellngton 6143 Phone Emal nfo@fso.nz Our prvacy polcy We are commtted to protectng the prvacy and securty of the personal nformaton we collect. We work to comply wth our oblgatons under the Prvacy Act 1993, ncludng the Health Informaton Prvacy Code Our prvacy polcy explans how we may collect, use and dsclose personal nformaton. Read t at nb.co.nz/about-us/prvacy-polcy 23

24 Everyday Cover Polcy document Need help? Go to nb.co.nz Emal us at 2017 nb nz lmted. All rghts reserved. nb804610_0717