Southern Cross Health Insurance – responding to member needs with important policy updates

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Southern Cross Health Insurance (SCHI) has revealed key policy updates which will be effective from 22 October 2024.

Thursday, August 15th 2024, 9:17AM 1 Comment

The updates are designed to meet the changing needs of the Friendly Society’s 955,000 plus members, to improve accessibility, and to address increases in the cost of healthcare. SCHI has also re-written some of its policy documents using plain language so they’re easier to understand[1].

Regan Savage, Chief Sales and Marketing Officer for SCHI says, “Our members’ health and wellbeing is at the heart of every decision we make. As New Zealand’s most trusted health insurance brand, it’s important we continue to offer benefits our members value. We’re focused on delivering the Southern Cross vision which is to empower our members to live well for longer. We believe the changes we’re introducing will contribute to this.

“Our team has been working diligently on product improvements for the majority of our policies[2] since the end of 2022, and I’m delighted to confirm the significant mahi they have done will be in place from 22 October to benefit our members.

“While we are increasing some benefits, we are also very mindful of costs to members and we’re using our contracting tools with Affiliated Providers accordingly. We’re also making it easier for our members to engage with Southern Cross by re-writing some of our policy documents in plain language to ensure members are better informed about their cover and how to get the help they need. We are also removing excess on some benefits.

“We listen closely to the feedback we receive from our members and are very much looking forward to seeing the positive impact as the changes roll out.”

Key changes include:

• Enhanced allowances for breast reduction and breast symmetry. Cover is enhanced for breast reduction and breast symmetry.

Savage says, “Breast surgery can be an emotional and life-impacting procedure and is often needed as part of cancer treatment. While we have long supported members to get the help they need for breast surgeries, we are now increasing benefit allowances in recognition of the increasing cost of delivering the procedures. Members on some of our most popular plans will benefit from an increase in cover up to $15,000 per lifetime for breast reduction surgery and an increase in breast symmetry cover to $10,000 per lifetime.”

The increased lifetime limits will apply to Wellbeing One, Wellbeing Two, KiwiCare, RegularCare and UltraCare policies. The restriction of one procedure per lifetime and the requirement that a breast symmetry surgery must take place within two years of the first eligible breast reconstruction following an eligible mastectomy will also be removed from all plans with cover for breast reduction and breast symmetry surgery.

• SCHI has also increased cover for other life-changing procedures under some plans such as Unilateral and Bilateral TMJ, Periurethral Injection (as a prosthesis) for incontinence, Cochlear Implant Receiver/Stimulator Prosthesis and Minimally Invasive Glaucoma Surgery (MIGS).
• The excess requirement has been removed from certain benefits for plans with an excess, e.g., surgical allowances, obstetrics and the GP minor surgery benefit.  For plans with an excess, the excess will only apply to claims for surgical procedures, chemotherapy for cancer (including Cancer Cover Plus) and radiotherapy. The excess will apply to each person covered under the policy once each claims year.
• More choice under psychiatrist consultation benefit.  Acknowledging the challenges in being able to access healthcare for mental health due to resource constraints throughout the motu, SCHI has made it easier for members with this benefit to access a psychiatrist by removing the requirement that consultations must be with an Affiliated Provider.
• More choice and higher benefit limit per year for mental health consultations for UltraCare members. SCHI will offer improved access to mental health services with a more flexible benefit providing an increased annual limit for mental health consultations. The existing separate benefits for psychiatrist consultations and clinical psychologist consultations will be removed and replaced with the new mental health consultations benefit. There will also no longer be a requirement that psychologists must be clinical psychologists.
• More healthcare services will be Affiliated Provider-only (this applies to all plans except UltraCare and HealthEssentials). SCHI has contracted more healthcare services which must be provided by an Affiliated Provider. This helps to manage costs to keep premiums as affordable as possible.
• List of Affiliated Provider-only healthcare services will only be available online. The list of healthcare services that must be performed by an Affiliated Provider will be moved out of the relevant policy documents and will only be available on the Southern Cross website. This will make it quicker for SCHI to introduce cover for new healthcare services through SCHI’s Affiliated-Provider network.  Members can view this online where it will be updated on 22 October 2024.
• SCHI is also revising its policy exclusions section, adding examples to aid understanding, removing words where they did not change the meaning, updating terminology and combining exclusions under the same heading where appropriate.
• Policy documents are easier to understand.  Many policy documents[3] have been re-written in plain language so it’s easier for members to understand their cover. Plus, SCHI has used a clearer layout, structure and used examples, to help make these policy documents simpler to navigate and understand. SCHI has earned WriteMark Plus accreditation for these policy documents, which shows that in addition to meeting the set of established plain language criteria, content has been rigorously tested with real members.
• SCHI is changing the way it communicates changes to the following documents that form part of some policies: the list of policy variations, eligibility criteria, the list of approved prostheses and specialised equipment, the unapproved healthcare services list, and the list of Affiliated Provider-only healthcare services. These lists will be regularly updated and posted on the SCHI website, including from 22 October 2024.

Southern Cross is committed to continual improvement

Savage says, “Healthcare is dynamic and fast-changing. Health technology, drugs and healthcare services are constantly being improved, so Southern Cross regularly reviews its policies and the way we engage with members, with an aim to remain sustainable and affordable.

“We’re driven to support our members’ healthcare journey, enabling them to live well for longer. That’s one thing that will never change.”

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