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The information below details the legal summary of changes to the Police Health Plan policy, effective 01 February 2022

 

1. The following benefits, as agreed, have been amended in the Policy:

  1. removed the provision of insurance cover and payment of claims for treatment when residing overseas, and instead reflecting this as an exclusion of the Policy;
  2. removed ‘Private Medical hospital Admission’ from not applying to excess terms;
  3. changed the mental health exclusion from ‘Mental disorders as defined in the Mental Health (Compulsory Assessment and Treatment) Act 1992’ to ‘Mental health services except as specifically provided by the psychiatrist consultation, psychiatric hospitalisation and clinical psychology benefits’;
  4. removed the ‘Aids/HIV’ exclusion;
  5. removed the ’18 month time limit on claims’ provision;
  6. collapsed the imaging, CT/MRI, and PET scan benefits into a single 'imaging’ benefit;
  7. amended the ACC terms to provide for a top up mechanism where PHPL pay any difference;
  8. amended the members right to residing in New Zealand or access to New Zealand public healthcare system term;
  9. removed information regarding premium rate for a child turning 19-years-old;
  10. added a ‘28 days’ written notice’ of cover changes or premium increases term;
  11. amended the definition of URC to include the geographic area of all of New Zealand.

 

2. The following terms, as agreed, have been introduced or amended in the Policy:

  1. an explanation of how the Policy works;
  2. an explanation of common words used in the Policy;
  3. an explanation of roles you might have under the Policy and how PHPL will contact members;
  4. cover names have changed from ‘Basic’ and ‘Comprehensive’ to ‘Primary health plan basic’ and ‘Primary health plan plus’;
  5. an explanation that PHPL may apply exclusions or conditions as enhanced benefits provided under upgraded cover;
  6. additional information to allow uploading claims electronically via a portal on PHP’s website;
  7. additional information that claims must be signed by the primary member;
  8. change of terms from ‘All claim costs must be pre-approved by us’ to ‘We strongly recommend’, and ‘we pay such claims’ to ‘surgical pre-approvals’ in the ‘How to have your claim paid for’ section;
  9. change of terms from ‘person who pays the premiums’ to ‘paying to primary member’;
  10. change in the ACC terms from ‘work-related injury’ to ‘an injury’ and deleted reference to Gallagher Bassett;
  11. statement added that PHPL will only pay for treatment actually required at the time of claim to minimise costs;
  12. additional information regarding the need to submit a health declaration;
  13. addition of ‘first’ employment, ‘first’ marriage, and ‘first’ de-facto relationship to the first opportunity definition;
  14. amended the relevant ‘registered’ professional definitions to reflect the Health Practitioners Competence Assurance Act 2003;
  15. addition of ‘Registered Podiatrist’, ‘Registered Dietician’, and ‘Registered Nurse’ definitions.

Police Health Plan is proud to have received the Consumer People's Choice award for the third year in a row.  We're even more proud to be the only health insurer to receive the award in 2021.