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(04) 496 6800

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0800 500 122

Exclusions from cover

We will not pay a claim for any pre-existing condition unless it was disclosed and specifically accepted by us on your entry to your health plan.

You will not be covered in the event of any of the following:

  1. Acute hospital admissions (“acute” means an unplanned admission or a planned admission if the admission date is less than 48 hours after the date on which the decision to admit was made).
  2. Breast reduction procedures performed for any reason (a voluntary payment may be made towards the cost of breast reduction surgery – conditions apply, contact us for details).
  3. Cardiac pacemakers, implantable defibrillations, nerve appliances, hearing aids, cochlear implants and any other appliances (surgical, medical or dental) other than surgically implanted prostheses which have been approved by us.
  4. Chelation therapy or similar treatment as defined by us.
  5. Congenital conditions other than those existing in children who become a member of the health plan within three months of their date of birth.
  6. Contraceptives, whether prescribed or non-prescribed.
  7. Cosmetic treatment costs. However, remedial treatment may be considered by us (at our discretion) if such treatment relates to correction of previously qualifying treatment under the health plan.
  8. Costs not referred to under a particular plan option in the health plan policy.
  9. Disengagement or discharge from the New Zealand Police as shown by examinations and reports, or in respect of any other insurance claim.
  10. Expenses recoverable from a third party or under any contract of indemnity or insurance.
  11. Gender reassignment surgery and directly related healthcare services.
  12. Geriatric care, including geriatric hospitalisation and pre-senile dementia.
  13. Homeopathy, naturopathy, herbal medicine or any other alternative medicinal treatment.
  14. Implantation of teeth or costs of implants with the exception of impacted wisdom teeth or those costs covered under the Surgical Loyalty Benefit
  15. Maintenance examinations or medical check-ups including mole mapping or dermatological surveillance, health screening, physicals for life insurance, driving licence or any other third party requirements.
  16. Mental health services except as specifically provided by the psychiatrist consultation, psychiatric hospitalisation and clinical psychology benefits.
  17. Pregnancy, child birth or any consequences of pregnancy.
  18. Refractive surgery for the correction of short sight or long sight, including astigmatism.
  19. Related charges such as anaesthetist, hospital and x-ray.
  20. Self-inflicted injuries or illness, including disability or illness arising from the use of alcohol or drugs, including prescription medication.
  21. Sexual dysfunction.
  22. Snoring treatment and management.
  23. Sterilisation reversal.
  24. Surgery designed to assist or allow the implementation of orthodontic services.
  25. Technologies, pharmaceuticals, or medical procedures that have not been approved by us.
  26. Treatment for obesity (a voluntary payment may be made towards the cost of bariatric surgery – conditions apply, contact us for details).
  27. Treatment provided by any person outside New Zealand except as agreed by us.
  28. Treatment required due to an accident.
  29. Treatment where a condition detrimental to health is not evident, including preventative medicine and prophylactic healthcare services and vaccinations, unless otherwise authorised in writing by us.
  30. Unapproved healthcare services, unless otherwise authorised in writing by us.
  31. War injury or disability.

 

Exclusion of liability

We shall not be liable to you or any of your dependents for any act or omission of:

  • any hospital,
  • servants agents or employees of any hospital,
  • health professional, or
  • other person or corporation providing any of the services in respect of which Benefits are or may be paid under your health plan.

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.