Ultimate Health™ and Ultimate Health Max™

What is it?

Ultimate Health and Ultimate Health Max are our two most comprehensive covers, offering complete choice and flexibility for you and your family.

Both products start with the Base Cover, which provides cover for the big expenses like surgical, medical (non-surgical) and cancer treatment in a private hospital. Ultimate Health Max has the additional benefit of cover for Medsafe approved drugs that are not subsidised through PHARMAC for treatment at home and in a private hospital.

The wording for Ultimate Health Max is guaranteed, this provides you with the added security of knowing exactly what you are covered for when it is time to claim. Additionally, any favourable future changes to Ultimate Health Max will automatically be applied – such as the inclusion of new benefits and an increase in benefit limits.

To find out more, contact your financial adviser or click 'find an adviser' and we will put you in touch with someone who can help.

Why is it worth it?

  • Health questions at application which means you can be sure what you’re covered for
  • $300,000 surgical cover per person each year
  • $200,000 medical cover, including cancer treatment, per person each year
  • Your choice of nil, $250, $500, $1,000, $2,000, $4,000 or $6,000 excess per person per year
  • Your choice to add the following options: Specialist, Proactive Health, Serious Condition Financial Support, GP, Dental & Optical
  • 2.5% discount off your overall premium if you add your spouse, partner, parent, child and / or grandchild to your Ultimate Health / Ultimate Health Max policy
  • Each person on the policy can choose their own excess levels and options

What will I be insured for?

  • Conditions

  • Benefits

  • Options

Covered conditions under this plan

Ultimate Health™ and Ultimate Health Max™ provide coverage for all the conditions in the table below, provided the treatment is covered by one of the benefits on the policy. The policy documents for both products are available below under Insurance documents.

All ACC top-up claims
Hernia, appendix
Anus, haemorrhoids
Oral (excluding orthognathic surgeries)
Unerupted and impacted teeth
Sinus, nose, ears
Ankle, elbow
Circumcision
Tonsils, grommets, adenoids
Skin lesion – GP
Skin lesion – specialist
Digestive tract, liver, kidney, pancreas, gall bladder
Breast, gynaecology, urology
Cancer surgeries and treatment
Shoulder, wrist
Varicose veins
Hip, knee
Heart
Brain, eyes, neck
Gland, vascular
Chest, back
Foot, toe, hands, fingers and thumbs
Non-surgical hospitalisation
 

Benefits of Ultimate Health™ and Ultimate Health Max™

These benefits apply to the conditions covered by Ultimate Health™ and Ultimate Health Max™ (click on 'Covered conditions')
All benefit limits apply to each person on the policy (just in case you thought you'd have to share!)

Note: this is not the policy document. For all the legal bits, see the Ultimate Health™ and Ultimate Health Max™ policy document under 'insurance documents'.

Surgery
Surgery in a recognised private hospital.
Includes costs for:
  • Surgeon's operating fees
  • Anaesthetist's fees
  • Intensivist's fees
  • Hospital accommodation (e.g. the admitted patient's bed, a private room, excludes suites)
  • Operating theatre fees
  • Surgically implanted prosthesis (in line with the prosthesis schedule)
  • Laparoscopic disposable
  • In-hospital X-ray examination and ECG
  • Intensive post-operative care and special in-hospital nursing
  • In-hospital post-operative physiotherapy
  • Ancillary hospital charges (e.g. dressings, sutures, needles, bandages)
  • In-hospital pharmaceutical prescriptions (in line with the PHARMAC Pharmaceutical Schedule A to H; Ultimate Health Max only: also includes non-PHARMAC drugs approved by Medsafe)
Oral surgery

Dental surgery in a recognised private hospital performed by a registered oral surgeon or maxillo-facial surgeon.

We will cover for removal of unerupted and impacted teeth (e.g. wisdom teeth) if a registered oral surgeon, dentist or maxillo-facial surgeon performs the surgery. A 12-month waiting period applies.

Cancer treatments
Covers costs for and relating to cancer treatment, including:
  • Chemotherapy, radiotherapy, and brachytherapy
  • Hospital accommodation (e.g. the admitted patient’s bed, a private room, excludes suites)
  • In-hospital X-ray examination and ECG
  • Intensive post-operative care and special in-hospital nursing
  • In-hospital post-operative physiotherapy
  • Ancillary hospital charges (e.g. dressings, sutures, needles, bandages)
  • In-hospital pharmaceutical prescriptions (in line with the PHARMAC Pharmaceutical Schedule A to H; Ultimate Health Max only: also includes non-PHARMAC drugs approved by Medsafe)
Follow-up investigations for cancer

Registered specialist consultation and diagnostic investigation following cancer treatment.

We cover one registered specialist consultation, and relevant diagnostic investigations each policy year. We pay up to $3,000 each year for up to five consecutive years.

ACC top up

Covers the difference in cost payable by ACC for a physical injury and the actual costs of surgery or medical treatment.

Hospital specialist consultations

Covers registered specialist consultations including visits to seek a second opinion up to six months before and six months after admission to a recognised private hospital.

No limits on each consultation. No limit on the number of consultations.

Hospital diagnostic investigations

Diagnostic investigations up to six months before and six months after admission to a recognised private hospital.

No limits per diagnostic investigation. No limit on the number of investigations.

Post-hospital physiotherapy

Physiotherapy up to six months after hospitalisation.

No limits on each consultation. No limit on the number of consultations.

Post-hospital home nursing care

Home nursing care up to six months after hospitalisation.

We pay up to $300 each day and $6,000 each policy year.

Travel and accommodation

Travel costs for you and a support person, and accommodation costs for a support person when you need to travel further than 100km from where you live for treatment and are an admitted patient in a recognised private hospital.

Surgery and medical treatment: we pay up to $5,000 each policy year.
Cancer treatment: we pay up to $5,000 each policy year.

Ambulance transfer
Road ambulance to and from a public hospital or recognised private hospital to another recognised private hospital.
Suspension of cover
After 12 months of continuous cover, you can put your cover on hold for up to six months due to unemployment or redundancy, for up to 12 months for parental leave, and up to 24 months for travel outside of New Zealand.
Waiver of premium
We cover the cost of all premiums on the policy for up to two years if a policyowner dies before age 65.
Funeral support benefit
We provide a cash payment of $3,000 if an insured person dies between the age of 16 and 64 (inclusive).
GP minor surgery

Minor surgery performed by a GP. Not limited to skin lesion surgery.

Ultimate Health: we pay up to $750 each policy year.
Ultimate Health Max: we pay up to $1000 each policy year.

Registered specialist skin lesion surgery

Skin lesion surgery performed by a registered specialist.

Ultimate Health: we pay up to $6,000 each year.
Ultimate Health Max: unlimited up to the hospital surgical maximum each policy year.

Varicose veins surgery

Varicose vein surgery performed by a registered specialist or medical practitioner who is registered with the Medical Council of New Zealand and a fellow of the Australasian College of Phlebology.

No limit on the number of procedures.

Non-surgical hospitalisation

Covers medical treatment (not involving surgery) in a recognised private hospital in relation to a medical condition (e.g. heart disease, asthma, pneumonia or diabetes).

We also cover the cost of associated intensive nursing care, X-rays, disposables and consumables, dressings and in-hospital pharmaceutical prescriptions (in line with the PHARMAC Pharmaceutical Schedule A to H; Ultimate Health Max only: also includes non-PHARMAC drugs approved by Medsafe).

In addition, this benefit covers less invasive procedures as an alternative to surgery.

Public hospital cash benefit

Provides a cash payment when you are admitted to a public hospital in New Zealand for three or more consecutive nights.

We pay up to $300 each night for the third and each subsequent night and up to $3,000 each policy year.

Major diagnostics (not related to hospitalisation)
Covers for the following diagnostic investigations, whether or not you have been hospitalised:
  • Arthroscopy
  • Capsule endoscopy
  • Colonoscopy
  • Colposcopy
  • CT Scan
  • CT Angiogram
  • Cystoscopy
  • Gastroscopy
  • MRI Scan
  • Myelogram
  • PET Scan
No limit per diagnostic investigation. No limit on the number of diagnostic investigations each year.
Parent accommodation

Accommodation costs for a parent or legal guardian accompanying an insured person under age 20 (inclusive) who is being treated in a recognised private hospital.

We pay up to $300 each night, and up to $3,000 each policy year.

Post-hospital therapeutic care

Includes osteopathic and chiropractic treatment, speech and occupational therapy, and dietician consultations up to six months after admission in a recognised private hospital.

We pay up to $1,000 each policy year.

Overseas treatment

Covers treatment and travel costs when treatment cannot be provided at all in New Zealand and the Ministry of Health has declined funding.

We cover up to $30,000 for each overseas treatment.

Cover in Australia

Covers costs for treatment undertaken in a recognised private hospital in Australia.

We pay up to 75% of the cost that would be payable in New Zealand for treatment performed in New Zealand.

Intravitreal eye injections

Intravitreal injections administered by a registered specialist and the cost of drugs administered (in line with the PHARMAC Pharmaceutical Schedule A to H; Ultimate Health Max only: also includes non-PHARMAC drugs approved by Medsafe).

We pay up to $3,000 each policy year.

Obstetrics

Treatment by an obstetrician for assessment and monitoring of recognised risk factors.

We pay up to $2,000 for each pregnancy.

Loyalty benefit – sterilisation

After two years continuous cover, we cover the cost of a male or female sterilisation as a means of contraception.

Ultimate Health: we pay up to $1000.
Ultimate Health Max: unlimited up to the hospital surgical maximum.

Loyalty benefit – wellness

Provides you with a reimbursement every three years of continuous cover to help proactively take care of your health through a check up with a GP.

We pay up to $100 every three years per insured person aged 21 or over.

ACC treatment injury

Covers the cost of surgical treatment for any injury which occurred during treatment.

Delayed Care

Covers overseas treatment if you need to wait for treatment in a recognised private hospital in New Zealand for six months or longer.

We pay the cost that would be payable in New Zealand for treatment performed in New Zealand.

Medical misadventure

We provide a lump sum payment of $30,000 if an insured person dies due to a medical misadventure.

Pre-existing cover for newborns

Cover for pre-existing conditions (other than congenital) for dependent children when added within four months of birth.

Ultimate Health Max™ only
Non-PHARMAC drugs

Covers the cost of drugs that are Medsafe approved but not subsidised by the government for use in a recognised private hospital, and for use at home for up to six months after an admission in a recognised private hospital.

Premium waiver extension

We cover the cost of all premiums on the policy for up to six months if the policyowner is diagnosed with a terminal illness before age 65.

Cancer treatment accessories support

Cover the cost of a wig, hat, scarf or mastectomy bras during or within six months after cancer surgery or treatment.

Cancer treatment counselling and support services

Covers the cost of counselling and support services that occur within six months after an admission to a recognised private hospital for a cancer surgery or treatment.

Cardiac counselling and support services

Covers the cost of counselling and support services that occur within six months after an admission to a recognised private hospital for a heart surgery.

Hospice care

Provides a payment when you are admitted to a Hospice for three or more consecutive nights.

We pay up to $300 each night for the third and each subsequent night and up to $3,000 each policy year.

Loyalty benefit – post mastectomy grant to achieve breast symmetry

After 12 months continuous cover, we provide a one-off payment towards the cost of unilateral breast reduction surgery to achieve breast symmetry post-mastectomy.

We pay a one-off grant of up to $4,000 per insured person.

 

Additional options on Ultimate Health™ and Ultimate Health Max™

Add options to your Ultimate Health™ or Ultimate Health Max™ Base Cover to tailor your policy to your needs. Each person on your policy can choose the options that suit them. If you choose an excess, this does not apply to the options.

Note: this is not the policy document. For all the legal bits, see the Ultimate Health™ or Ultimate Health Max™ policy document under 'insurance documents'.

Specialist Option

Covers you for specialist consultations and diagnostic procedures that don’t result in hospitalisation.

Key features:

  • Unlimited number of visits for registered specialist consultations, including visits to seek a second opinion
  • General diagnostic: up to $3,000 each policy year for costs such as X-rays, arteriogram, ultrasound, scintigrapy, mammography or visual field tests
  • Cardiac investigations: up to $60,000 each policy year for costs such as cardiovascular ultrasound, echocardiography and treadmills
  • Cover for sports physician treatment up to $500 each policy year
  • Cover for pre-existing conditions (other than congenital) for dependent children when added within four months of birth
Proactive Health Option

This option encourages you to look after your health, whether you want to check any hereditary medical concerns, or just want to stay fit and healthy.

The premium for this option is one set price, regardless of your age, gender or smoking status. Plus you’ll get up to a maximum of $1,400 worth of cover a year.*

  • Health screening: up to $750 each policy year for:
    • Breast screening
    • Cervical screening
    • Prostate screening
    • Bowel screening
    • Heart screening
    • Mole mapping
    • Eye and visual field tests
    • Hearing tests
    • Bone screening
  • Allergy testing and vaccinations: up to $100 each policy year
  • Dietitian / nutritionist consultations: up to $300 each policy year
  • Gym membership, weight loss management programmes and quit smoking programmes: up to $100 each policy year
  • Routine health check benefit: $150 for each person after each two years of continuous cover on this option to put towards a medical examination by a GP.

* Covers 80% of the cost up to the above benefit maximums. A waiting period of six months applies.

Serious Condition Financial Support Option

This option pays out a one-off lump sum to help reduce the strain of dealing with specific trauma conditions.

You can use this lump sum for whatever you wish, such as expensive out-of-hospital drug treatments, rehabilitation expenses, paying off the mortgage or maybe a holiday to recuperate.

Key features:

  • Choice of cover - $20,000 or $50,000
  • Covers 39 trauma conditions, including:

    Heart and Circulation

    • Aortic surgery*
    • Cardiac arrest – out of hospital*
    • Cardiomyopathy*
    • Coronary artery angioplasty* (3 vessels or more)
    • Coronary artery bypass grafting surgery*
    • Heart valve surgery*
    • Major heart attack* (myocardial infarction)
    • Primary pulmonary hypertension*

    Organs

    • Chronic liver failure
    • Chronic lung failure
    • Chronic renal failure
    • Major organ transplant*
    • Pneumonectomy

    Functional loss / neurological

    • Advanced dementia (including Alzheimer’s disease)
    • Benign tumour of the brain and spinal cord*
    • Coma
    • Encephalitis
    • Loss of independent existence
    • Major head trauma
    • Motor neurone disease
    • Muscular dystrophy
    • Multiple sclerosis
    • Paralysis
      • Hemiplegia
      • Diplegia
      • Paraplegia
      • Quadriplegia
      • Tetraplegia
    • Stroke*
    • Parkinson’s disease

    Loss of use

    • Deafness
    • Loss of limbs and / or sight
    • Total and permanent blindness
    • Loss of speech

    Blood disorder

    • Aplastic anaemia

    Cancer

    • Cancer – life threatening*

    Other conditions

    • Intensive care
    • Severe burns
    • Medically acquired HIV
    • Occupationally acquired HIV
  • Free cover for your children under this option, up to half of the sum insured.
  • Additional payment for paralysis equal to your sum insured amount.

* If any of these conditions occur within 90 days of the commencement date, effective date or join date of this option (whichever is applicable), or the date cover is reinstated, no amount is payable.

GP Option

Perfect for those wanting to cover some of the day-to-day healthcare costs*. This option is particularly useful if you develop a health problem requiring regular GP consultation.

Key features:

  • GP visits: 12 GP visits each policy year; up to $55 for each visit, up to $80 for each home visit, up to $25 for each ACC top-up visit, and up to $200 for each minor surgical procedure
  • Prescriptions: up to $15 each prescription, up to $300 each policy year
  • Physiotherapy: up to $40 each visit, up to $400 each policy year
  • Active Wellness Benefit: $150 for each adult towards the cost of fitness equipment or gym membership, after each two years of continuous cover (provided your total claims under the GP Option are less than $150)
  • Nurse visits: up to $30 each visit, up to six visits each policy year.
  • Cover for pre-existing conditions (other than congenital) for dependent children when added within four months of birth.

* Covers 100% of the cost up to the above benefit limits. A waiting period of 90 days applies.

Dental & Optical Option

Ideal if you have regular trips to the dentist, optometrist, chiropractor, podiatrist or osteopath, or if you need glasses or contacts from a change in vision*.

Key features:

  • Dental treatment: up to $500 each policy year
  • Eye care: up to $55 each visit, up to $275 each policy year, and up to $330 each policy year for glasses or contact lenses
  • Ear care: up to $250 each policy year for audiology treatments, and up to $250 each policy year for audiometric tests
  • Spinal care: up to $40 each visit, up to $250 each policy year, and up to $80 each policy year for X-rays
  • Joint care: up to $40 each visit, up to $250 each policy year
  • Foot care: up to $40 each visit, up to $250 each policy year
  • Speech, occupation and eye therapy: up to $40 each visit, up to $300 each policy year
  • Acupuncture: up to $40 each visit and up to $250 each policy year
  • Cover for pre-existing conditions (other than congenital) for dependent children when added within four months of birth.

* Covers 80% of the cost up to the above benefit maximums. A waiting period of six months applies.

Insurance documents