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Affiliated Provider-only healthcare services

In all Southern Cross health insurance policies (except UltraCare) a number of procedures are only eligible for cover if they are performed by an Affiliated Provider. Unless you are advised otherwise by Southern Cross or your Affiliated Provider, we will pay:

  • for RegularCare, KiwiCare and First Cover plans, 80% of the amount charged by your Affiliated Provider for the procedure up to policy limits.
  • for all other plans (except UltraCare) , 100% of the amount charged by your Affiliated Provider for the procedure up to policy limits.

You can search for an Affiliated Provider here.

Please be aware that not all healthcare services are available from all Affiliated Providers or in all areas. In order to receive cover, the healthcare services must be approved treatment and meet applicable eligibility criteria. Members must also meet the terms and conditions of their policy at the time the services are provided.

For full details, please refer to your policy document.

Simply select the healthcare service you require from the list below to understand what you need to do to confirm cover for your treatment.

Allergy

For the healthcare services below find an Affiliated Provider here

  • Drug challenge testing for allergy
  • Food challenge testing for allergy
  • Initial and follow up consultations for allergy
  • Injection for allergy
  • Skin testing for allergy
  • Desensitisation

Cancer care

For the healthcare service listed below check here to find an affiliated provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Radiotherapy (including radiotherapy planning and radiation treatment)

Cardiology

For the healthcare services listed below check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Advanced electrocardiogram (AECG)
  • Catheter based cardiology procedures including:
    • coronary angiogram and / or angioplasty
    • electrophysiology studies and ablation of cardiac arrhythmias
    • percutaneous patent farmen ovale (PFO) closure
    • percutaneous atrial septal defect (ASD) closure
  • CT coronary angiogram
  • Peripheral angiogram and / or angioplasty

Cardiac surgery

For the healthcare services below call 0800 800 181 to confirm the process

  • Conorany artery bypass graft surgery (CABG)
  • Valve replacement
  • Valvuloplasty

Ear, nose and throat (ENT)

For the healthcare services listed below check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Adenoidectomy
  • Balloon sinuplasty
  • Endoscopic modified Lothrop
  • Grommets (insertion and / or removal of grommets in theatre)
  • Laser treatment for pharyngeal, laryngeal and oesophageal conditions
  • Tonsillectomy

General surgery

For the healthcare services listed below (unless stated otherwise) check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Cholecystectomy
  • Gastrointestinal endoscopy
    • gastroscopy
    • colonoscopy
    • balloon enteroscopy
    • wireless pH capsule (wireless capsule endoscopy)
  • Hernia repair (femoral, hiatus, inguinal and umbilical hernia repair)
  • Sacral nerve stimulation
    • Please note, there will be no reimbursement for the cost of the stimulation device
  • Varicose vein (cover limited to two varicose vein leg procedures per leg, per lifetime)
    • endovenous laser treatment
    • ultrasound guided sclerotherapy
    • varicose vein surgery
    • radiofrequency (RF) endovenous ablation
    • duplex vein mapping
  • Contrain biofeedback and electrostimulation for faecal incontinence
    • Please note, there will be no reimbursement for the cost of the stimulation device
    • find an Affiliated Provider here

Imaging

For the healthcare services listed below (unless stated otherwise) check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • CT angiogram
  • MR angiogram
  • Computer axial tomography (CT scan)
    • Please note, cone beam computed tomography (CBCT) must be referred by a specialist in private practice
  • Magnetic resonance imaging (MRI Scan)
    • Please note, must be referred by a specialist in private practice
  • Positron emission tomography / computed tomography (PET/CT)
    • Please note, cover is limited to specific diagnosed cancers and must be referred by a specialist in private practice
  • Mammography (transition period applies ) - call 0800 800 181 to confirm the process

Interventional radiology

For the healthcare services listed below (unless stated otherwise) check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Radiofrequency ablation of benign bone lesions (transition period applies )
  • Superficial vascular malformation sclerotherapy and embolisation – simple (transition period applies )
    • Please note, cover is limited to two procedure per vascular malformation per lifetime
  • Percutaneous medial branch thermal radiofrequency neurotomy
    • Please note, cover is limited to two procedures per lifetime - find an Affiliated Provider here

Ophthalmology

For the healthcare services listed below (unless stated otherwise) check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Bleb needling (transition period applies)
  • Cataract surgery
    • Please note, limited to the insertion of a standard monofocal intraocular lens only (there is no cover for the additional cost of any other type of surgically implanted intraocular lens or associated costs)
  • Corneal crosslinking
  • Corneal topography (transition period applies)
  • Entropion and ectropion repair (transition period applies)
  • Excision of pterygium
  • Excision of pinguecula
  • Fundus photography (transition period applies)
  • Fundus fluorescein angiography (transition period applies)
  • GDx retinal scanning
  • Heidelberg retinal tomography (HRT)
  • Initial and follow up consultation for ophthalmology (transition period applies)
    • Call 0800 800 181 to confirm the process
  • Intraocular pressure test (IOP) (transition period applies)
  • Intravitreal injections
    • Please note, cover for drug costs is limited to $100 per injection regardless of the type of drug used
  • Laser eye treatment
    • YAG laser capsulotomy
    • laser iridotomy
    • laser iridoplasty
    • laser trabeculoplasty
    • photocoagulation of the retina
    • pan retinal laser
    • macular laser
  • Matrix screen (transition period applies)
  • Minor eyelid surgery (transition period applies)
  • Optic disc photos (transition period applies)
  • Optical coherence tomography (OCT)
  • Probing / syringing of lacrimal passage (transition period applies)
  • Ptosis (transition period applies)
  • Removal of tarsal cyst (transition period applies)
  • Retinal photography (transition period applies)
  • Upper eyelid blepharoplasty (transition period applies)
  • Visual field tests (transition period applies)
  • Vitrectomy (transition period applies) - call 0800 800 181 to confirm the process

Oral surgery

For the healthcare service listed below check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Tooth extraction
    • Please note, no cover for RegularCare and KiwiCare policies

Orthopaedic surgery

For the healthcare services listed below (unless stated otherwise) check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Synthetic ligament repair and reconstruction (transition period applies)
  • Carpal tunnel release
  • Hip joint replacement (primary total hip joint replacement)
  • Knee joint replacement (primary total knee joint replacement and primary partial hemi knee joint replacement)

Skin

For the healthcare services below find an Affiliated Provider here

  • Mohs surgery (includes cover for excision and closure)
  • Excision of skin lesion
  • Skin biopsy (transition period applies) (only applies if under general anaesthetic)
  • Currettage and diathermy (transition period applies) (only applies if under general anaesthetic)
  • Cryotherapy (transition period applies) (only applies if under general anaesthetic)

Urology

For the healthcare services listed below (unless stated otherwise) check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm.

  • Prostate treatment
    • laparoscopic prostatectomy
    • prostate brachytherapy
    • external beam radiotherapy
    • prostate cryotherapy
    • radical retropubic prostatectomy
    • perineal prostatectomy
    • transurethral resection of prostate (TURP)
    • open enucleation of prostate
    • laser resection of prostate
    • robotically assisted laparoscopic prostatectomy
  • Laparoscopic renal cryotherapy
  • Vasectomy
    • Please note, this is a loyalty benefit, there is no cover on SureCare or SureCare Concessionary policies and no cover for reversals
  • Robotic partial nephrectomy - find an Affiliated Provider here

What is a transition period?

A transition period is the time between a healthcare service becoming ‘Affiliated Provideronly’ and, in our view, there being sufficient Affiliated Providers in place to provide that healthcare service. If there is a transition period, we'll continue to issue prior approvals for those healthcare services until we have sufficient Affiliated Providers in place.

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Terms of use Financial Strength Rating and Solvency

For full details on the terms and conditions (and exclusions), please refer to the policy document or contact us.

Southern Cross Medical Care Society (trading as Southern Cross Health Society) has an A+ (Strong) financial strength rating given by Standard & Poor’s (Australia) Pty Limited. The rating scale is: AAA (Extremely Strong), AA (Very Strong), A (Strong), BBB (Good), BB (Marginal), B (Weak), CCC (Very Weak), CC (Extremely Weak), SD or D (Selective Default or Default), R (Regulatory Action), NR (Not Rated). Ratings from ‘AA’ to ‘CCC’ may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories. Full details of the rating scale are available at www.standardandpoors.com. Standard & Poor’s is an approved rating agency under the Insurance (Prudential Supervision) Act 2010.

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@ Southern Cross Medical Care Society
Terms of use Financial Strength Rating and Solvency

*For full details on the terms and conditions (and exclusions), please refer to the policy document or contact us.

Southern Cross Medical Care Society (trading as Southern Cross Health Society) has an A+ (Strong) financial strength rating given by Standard & Poor’s (Australia) Pty Limited. The rating scale is: AAA (Extremely Strong), AA (Very Strong), A (Strong), BBB (Good), BB (Marginal), B (Weak), CCC (Very Weak), CC (Extremely Weak), SD or D (Selective Default or Default), R (Regulatory Action), NR (Not Rated). Ratings from ‘AA’ to ‘CCC’ may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories. Full details of the rating scale are available at www.standardandpoors.com. Standard & Poor’s is an approved rating agency under the Insurance (Prudential Supervision) Act 2010.