Priority Health Business

Surgical list 2013 - 2014

This is the surgical list that lists the surgical procedures covered under the 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 diagnostic list.

The surgical procedures on this surgical list have been grouped together for customer friendly use. In addition, descriptions are provided to explain the surgical 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 surgical 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 surgical list as well as the Priority Health Business diagnostic list to your doctor who will be able to tell you if the procedure being recommended is on the list.

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

In order for any surgical procedure undertaken to be covered it must appear with a ✓ in the list for the corresponding Base Cover: Major Surgical Module or Module 1: Other Surgical Cover (if taken by you). Any diagnostic procedure undertaken relating to the surgical procedure must be listed in the diagnostic list for the respective module and performed within four months prior to the date of admission to an approved private hospital for surgery.

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

Your registered specialist recommends that you have a breast mastectomy. This surgical procedure is listed under the Base Cover: Major Surgical Module. You call for pre-approval before undertaking the surgery and your surgery is covered. Any associated diagnostic procedures undertaken up to four months before surgery and listed under Base Cover: Major Surgical Module (such as a Bilateral Breast Ultrasound and Breast Fine Needle Aspiration), will also be covered.

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

Your registered specialist recommends that you have a septoplasty. This surgical procedure is listed under Module 1: Other Surgical Cover. You call for pre-approval before undertaking the surgery and the surgery is covered. Any associated diagnostic procedures undertaken up to four months before that surgery and listed under Module 1: Other Surgical Cover (such as a nasendoscopy will also be covered).

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 at 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 surgical list

BC = Surgical procedures that are covered under the Base Cover: Major Surgical Module
Mod 1 = Surgical procedures that are covered under Module 1: Other Surgical Cover

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