Benefits
Effective 1st April 2020
- New members can access benefits after the first 90 days of membership.
- All applications for benefits must be lodged within 12 months of receiving the treatment.
- Benefits apply to the cost of medical treatment or hospitalisation incurred within New Zealand.
- Per annum means the financial year from 01 April to 31 March, benefit limits relate to this period.
- On exceeding annual benefit limits, you may hold your receipts and access benefits in the next financial year subject to the 12 month claim period.
- Under Family membership, your natural and adopted children are included until they reach 19 years of age
after which they may take up their own single membership. - Children of partners who are not the employee's natural or adopted children can apply under a single membership.
- If you do not have a medical scheme or insurance, Koruhealth may refund up to 2/3 of the total invoice cost
(subject to benefit limits). GP fees and prescriptions may be refunded up to 100% (subject to benefit limits). - If you have a medical scheme or insurance, Koruhealth may refund the remaining balance of each invoice
up to 2/3 of the total invoice (subject to benefit limits). However, the remaining balance of GP fees and
prescriptions may also be refunded to 100% (subject to benefit limits). - Koruhealth is a Provident Society and all benefits are at the ultimate discretion of the Board.
Alternative Treatments
Examples of some of the alternative treatments covered are as follows
– Homeopathy, Naturopathy, Herbal and Acupuncture.
Medical / Hospital
Examples of some of the costs covered are as follows – surgery and associated costs performed by an NZ Registered Specialist. This is a per illness benefit.
Examples of some of the costs NOT covered are as follows:- Cosmetic and oral surgeries, including Dental surgery, Fertility and Weight Loss treatments.
Health Services
Examples of some of the costs covered are as follows – equipment hire, medical tests such as ECG, lab tests such as blood work, ambulance / ambulance subscription, occupational therapy, dietitian, varicose vein stockings, mole mapping and skin surgeries.
Specialist – NZ Registered ONLY
Examples of Specialists are Oncologists, Dermatologists and Endocrinologists.
Orthodontic – NZ Registered ONLY
The total benefit limit is for a maximum of $800 per dependant, up to the age of 19.
KoruHealth members are required to use NZ Registered Orthodontic Specialists.
Optical
Claims are limited to spectacles and contact lenses purchased in New Zealand.
Funeral
Claims must be received within 12 months of death and a certificate must be supplied with the claim.
Birth
Claims must be received within 12 months of birth and a certificate must be supplied with the claim. The birth benefit may only be covered if fees are being paid whilst on leave without pay. If membership is suspended or the member is in their stand down period, this cannot be claimed.
X-Rays
Dental x-rays are not covered.
Laser Eye/Refractive Lens Treatment
This is a per eye benefit.
| Benefit Type | Cover |
|---|---|
| GP Fees* | $600 per annum for Single $1000 per annum for Married/Family |
| Prescriptions* | $400 per annum for Single $600 per annum for Married / Family |
| X-Rays** | $500 per annum for Single |
| Specialist** | $180 per visit |
| Medical / Hospital | $3,500 per illness |
| Osteopathy/Chiropractic/ Physiotherapy** | $300 per annum for Single |
| Alternative Treatments** | $300 per annum for Single |
| Podiatry** | $300 per annum for Single |
| Orthodontic** | $800 per dependant (Total benefit limit) |
| Optical (NZ Purchases Only) | $180 for first claim |
| Hearing Aids*** | $500 per aid every 5 years |
| Laser Eye/Refractive Lens Treatment** | $500 per eye. |
| Health Services** | $300 per annum for Single |
| Counselling** | $300 per annum for Single |
| Psychology/Psychiatry** | $500 per annum for Single |
| Birth Benefit | $50 per child. Must claim within 12 months |
| Funeral | $1,000 per member (Current Employee) |
| Misc. Discretionary | On application to the board |
GP Fees*
$600 per annum for Single
$1000 per annum for Married/Family
Prescriptions*
$400 per annum for Single
$600 per annum for Married / Family
X-Rays**
$500 per annum for Single
$750 per annum for Married/Family
$500 per MRI/CT scan image
Specialist**
$180 per visit
Medical / Hospital
$3,500 per illness
Osteopathy/Chiropractic/
Physiotherapy**
$300 per annum for Single
$450 per annum for Married/Family
Alternative Treatments**
$300 per annum for Single
$450 per annum for Married/Family
Podiatry**
$300 per annum for Single
$450 per annum for Married/Family
Orthodontic**
$800 per dependant (Total benefit limit)
Optical (NZ Purchases Only)
$180 for first claim
$120 every 3 years
Hearing Aids***
$500 per aid every 5 years
Laser Eye/Refractive Lens Treatment**
$500 per eye.
Health Services**
$300 per annum for Single
$450 per annum for Married/Family
Counselling**
$300 per annum for Single
$450 per annum for Married/Family
Psychology/Psychiatry**
$500 per annum for Single
$750 per annum for Married/Family
Birth Benefit
$50 per child. Must claim within 12 months
Funeral
$1,000 per member (Current Employee)
$400 per member (Past Employee/Retiree)
$400 per Spouse and Dependant
Misc. Discretionary
On application to the board
NB Dental and fertility benefits are not covered. All payments are at the discretion of the Board.
*GP and prescription fees may be refunded up to 100% within annual limits.
**Koruhealth may refund other benefits up to 2/3's of the invoice within annual or maximum limits – refer to guidelines.
***Every 5 years