Members on Basic and Plus plans can have CT, MRI and PET scans arranged with the provider for direct payment.

Surgical Plan Cover

If you are on our Surgical plan and need a scan to determine whether you need surgery, you will need to pay for the scan. If the scan leads to surgery, and Health Plan approves cover for the procedure, you can be reimbursed for the costs within 4 months of the scan taking place .

How to apply

Before starting the claim, please make sure you have an electronic version of your documents ready, PDFs are preferred but you can also upload these as jpgs, please make sure these are nice and clear images. 

To submit a surgical prior approval request, log into the NZPA website, go to your dashboard and click on the health plan portal tile. This will take you to your health plan portal where you can lodge your claim. On the “Add a new claim” tile click “Start Claim”.  For a surgical prior approval click “Get approval” and follow the steps to lodge your claim details.  

Log into my Health Portal

Process after form is submitted

Our Health Plan team will contact the provider directly to allow them to send the invoice directly to us, if you receive an invoice please send this through to us for payment. This will be deducted from your annual allowance for CT, MRI, PET scans (unless within 4 months of a surgical procedure we have approved) If there is a shortfall on your cover you will be notified of the shortfall amount and where to pay this to after Health Plan has paid their portion. Annual allowances are as follows:

For Basic cover: You can claim a 80% refund, with an annual maximum of $4,800.

For Plus cover: You can claim a 100% refund, with an annual maximum of $6,000.

The benefit year runs from 1 July to 30 June.

If you have Basic Cover, or your scan costs more than the maximum amount that you are covered for, we will confirm where to pay the shortfall once we have received the invoice from the provider and have paid Health Plan’s portion of the cost.