Priority Health Business

Diagnostic list 2013 - 2014

This is the diagnostic list that lists the diagnostic procedures for Priority Health Business policy and must be read in conjunction with:

  • The policy document for Priority Health Business Base Cover: Major Surgical Module, and any other policy document(s) for any chosen module(s), and
  • The acceptance certificate or renewal certificate, and
  • The Priority Health Business surgical list

The diagnostic procedures on this diagnostic list have been grouped together for customer friendly use. In addition, descriptions are provided to explain the diagnostic procedures covered under the relevant modules under Priority Health Business.

This list applies from 1 July 2013 and is reviewed on 1 July every year and may be updated. If your policy is part of a subsidised health scheme, this list will take effect from your next group anniversary date.

Pre-approval for claims

It is important that you obtain pre-approval before you have a diagnostic procedure by calling 0800 123 nib (0800 123 642)0800 123 nib. This process will confirm what is covered and what is required for you to make a claim. Take a copy of this diagnostic list as well as the Priority Health Business surgical list to your doctor who will be able to tell you if the procedure being recommended is on the list.

If any pre-approved diagnostic procedure leads to a pre-approved surgical procedure during the diagnostic procedure being performed, the Benefit maximum of that pre-approved diagnostic procedure will be reviewed accordingly.

Base Cover: Major Surgical Module and Module 1: Other Surgical Cover

In order for any diagnostic procedure undertaken to be covered it must:

  • appear with a ✓ in the list below for the corresponding Base Cover: Major Surgical Module or Module 1: Other Surgical Cover (if taken by you), and
  • relate to a surgical procedure in the respective module, and
  • be performed within four months of the admission date for that surgical procedure

For example – you have the Base Cover: Major Surgical Module*

Your registered specialist recommends that you have a Bilateral Breast Ultrasound and Breast Fine Needle Aspiration (FNA). These diagnostic procedures are listed below under the Base Cover: Major Surgical Module. Within four months of having these diagnostics, a mastectomy surgical procedure is undertaken. Mastectomy is a listed surgical procedure under Base Cover: Major Surgical Module and is covered. Because the diagnostic procedures relate to this surgery, they are covered under the Procedure-Related Diagnostics Benefit in the Base Cover: Major Surgical Module, with a benefit maximum of $4,000 per insured person, per policy year.

For example – you have Module 1: Other Surgical Cover*

Your registered specialist recommends that you have a Nasendoscopy. This diagnostic procedure is listed below under Module 1: Other Surgical Cover. Within four months of having this diagnostic procedure, a septoplasty surgical procedure is undertaken. Septoplasty is a listed surgical procedure under Module 1: Other Surgical Cover and is covered. Because the diagnostic procedure undertaken relates to this surgery, it is covered under the Procedure-Related Diagnostics Benefit in Module 1: Other Surgical Cover, with a benefit maximum of $4,000 per insured person, per policy year.

Module 2: Cancer and Non-Surgical Hospitalisation Cover

Diagnostic procedures in Module 2: Cancer and Non-Surgical Hospitalisation Cover must be undertaken in connection with private chemotherapy, radiotherapy or brachytherapy for cancer, and within the four months immediately before and after the date of treatment or admission to an approved private hospital.

Module 5: Specialist and Diagnostic Cover

Diagnostic procedures in Module 5: Specialist and Diagnostic Cover covers diagnostic procedures that do not relate to a covered surgical procedure or fall outside the four months time frame from your covered surgical procedure or chemotherapy, radiotherapy or brachytherapy treatment.

Exclusions

There are times when a claim may not be covered. Please check your acceptance certificate or renewal certificate for specific exclusions and your policy document which sets our standard exclusions. A copy of the policy wording can be downloaded from www.nib.co.nz or contact us on 0800 123 nib (0800 123 642)0800 123 nib.

*This is an example only. Please refer to your policy wording for full terms and conditions of cover.

Keys to the Priority Health Business diagnostic list

BC = Base Cover: Major Surgical Module Mod 1 = Module 1: Other Surgical Cover
Mod 2 = Module 2: Cancer and Non-surgical hospitalisation Cover Mod 5 = Module 5: Specialist and Diagnostic Cover

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