It’s good to claim.
We're always looking for ways to make sure our members get the most out of their health insurance and to make it easy to manage and use their policy.
Here, you'll find how to make a claim, view documents and also how to contact a financial adviser in your local area.
Frequently asked questions
Who is HealthCarePlus?
HealthCarePlus is the trading name for The Education Benevolent Society Incorporated (“EBS”). EBS was started in 1963 to enable teachers, education sector members, and their families to access competitive insurance products to support their families’ health and provide financial protection for unforeseen events.
From 1 January 2019 HealthCarePlus assumed the role of marketing the HealthCarePlus insurance products which from that date are underwritten by Union Medical Benefits Society (UniMed).
Who is UniMed?
UniMed was established in 1979 and provides a comprehensive range of health insurance plans. Like HealthCarePlus, UniMed was established by Unions to provide its members with health insurance benefits, is a New Zealand owned licensed insurer and a not-for-profit organisation.
UniMed is currently one of New Zealand’s top four health insurers when measured by both revenue and membership¹. They are an established, professional health insurer with an excellent reputation and proven financial strength. UniMed has an A (Excellent) Financial Strength Rating from AM Best Company. To view the rating visit their website at www.unimed.co.nz/about-unimed/financial-strength/
¹Source: Health Funds Association of New Zealand
- What are my options for paying premiums?
When does cover start?
Cover commences from the date of the first premium payment and after prerequisite Waiting/Qualifying Periods have been served.
What if I change my mind
If you are joining HealthCarePlus for the first time and are not satisfied with the policy during the first 14 days after the date that you received your policy document and your Membership Certificate, you can cancel the policy and we will provide a refund of all premiums paid. If you wish to cancel the policy within the 14 day period please contact us on 0800 600 666, or email@example.com.
How does the HealthCarePlus Claim Process work?
For 'day to day' expenses including specialist visits or diagnostic testing, you will need to pay the invoice yourself and claim back up to 50% subject to annual limits under your HealthCarePlus ‘day to day’ plans - click here to complete your form & attached copies of the receipts you have paid.
If you have a linked Hospital Cover plan, contact your insurer to arrange prior approval. For specialist visits and some testing, you will need to pay invoices and claim reimbursement from the insurer attaching copies of your receipts. If you require surgery or more expensive diagnostic testing, the insurer will usually pay the provider directly less any excess, as long as you have received your prior approval from them first. Claiming will be limited to a maximum of 100% of costs if you have both 'day to day' and hospital cover plans.
Where do I find claim forms?
For ‘day to day’ plan claims, please follow the instructions here: https://healthcareplus.org.nz/member-services#claims
For Hospital Cover claims visit the claims section of your insurer’s website to find instructions, or contact your HealthCarePlus representative if you are unable to locate the forms.
Do the Primary Care plans cover pre-existing conditions? If yes, When can I claim?
Yes, Primary Care plans cover pre-existing conditions after short initial wait periods. You are eligible to claim benefits on your policy. Please refer to your policy document to find out more about waiting periods or call us on 0800 600 666.
It has been more than 12 months since my treatment/surgery can I still claim?
Yes. Claims over 12 months old are still eligible so please send them in for processing. Remember, if you have lost your receipts, you can contact your medical provider to obtain a copy of the invoice that you can then submit for a refund.
For surgical claims your insurer typically pays the provider directly. If you have paid and are seeking an excess refund, we suggest that you submit your claim as soon as possible so that you can receive your refund.
I have upgraded from Primary Care to Primary Care Extra. When can I claim the extra benefits?
You will serve the waiting period applicable under Primary Care Extra for all benefits that are not included in Primary Care or #Care4U. These additional waiting periods apply over and above the standard waiting periods for Primary Care or #Care4U. Please refer to the Terms and Conditions here
What value of claims should I accumulate before I submit a claim?
Please submit your claim to Unimed at any value. We strongly recommend you claim regularly to get the most out of your day to day plan.
Can someone else sign the claim form on my behalf?
Unless that person has Power of Attorney you as the Member must sign the claim form.
When will my claim be paid?
Unimed aims to process 'day to day' claims within 3 business days and if you have given them your bank account details, we will direct credit the reimbursement into your bank account on the same day that they process the claim. This time frame may vary over holiday periods. Once your claim has been paid a Claim Advice notification will be sent by email or mail to you outlining how your claim has been assessed.
If I exhaust my year’s entitlement can I submit receipts in the following year?
No, claims are assessed based on when the healthcare service is undertaken, not when the claim is made. Claims can not be submitted to be deducted from the following year’s entitlement.
What prescription drugs are covered?
All drugs prescribed for a medical condition, by a registered medical practitioner and purchased from a pharmacy are covered. A maximum limit of $10 per item applies for Primary Care and #care4U. A maximum of $20 per item applies for Primary Care Extra.
Do the Primary Care plans include Hospital Cover or is that a separate cost?
Primary Care & Primary Care Extra are intended as ‘day to day’ medical care and include some low level benefits for Hospital treatment, however these plans are not intended to be held instead of Hospital Cover. Hospital Cover plans are needed to cover the larger costs of surgery or treatment in a private hospital.
How do day to day plans and Hospital Cover work together?
If you purchase a Hospital Cover plan through a HealthCarePlus Representative and also have a Primary Care or Primary Care Extra plan we can link these two plans so that you can claim back any surgical excess, up to $500. Refer to full policy wording.
- I have a linked and approved HealthCarePlus Hospital Cover policy, how do I claim the excess?
Can I claim for dentistry?
A Dental Benefit is available under Primary Care Extra and #care4U (50% of net expenses up to a calendar year entitlement of $250 applies). Dentistry is excluded under Primary Care.
Why is the dental benefit capped at $350?
In order to keep these plans at an affordable level, we need to cap the maximum claim amounts. If we increase the amount you can claim we will also need to increase the cost of the plans to ensure the plans are sustainable for all members.
Up to what age can children be included under my policy?
Children can be covered under your membership up to 21 years of age. Cover terminates at the end of the calendar year (31 December) following their 21st birthday. However, over 21 year old children may now be covered under their own membership at a Whanau/non union member rate!
Can my family/spouse join HealthCarePlus?
Yes both your partner and children under 21 can join on your plan. Any children over 21 can also join, linked through your membership number (over 21 year olds will pay non-union member rates unless they are also a member of a participating union in their own right)
How do I add or remove family members from the policy?
If you wish to add your partner or children (up to 21 yrs old) to your health plan, please complete our Online Additional Members Form here.
To remove famiily members, please advise in writting by sending emails to firstname.lastname@example.org.
My bank account has changed, where can I get a new direct debit form?
A new direct debit form can be downloaded from the website here, or by calling 0800 600 666.
- Will my premiums change?
Can I put my cover on hold?
Yes, if you are travelling overseas, your cover may be suspended from three months to up to one year over the life of the policy. Evidence of travel plans will be required for each case ie; tickets.
Am I covered while I'm overseas?
No. Our plans only provide cover for costs incurred within New Zealand, unless you are on approved overseas exchange or study leave, continue to have NZ salary paid to you and continue to pay your HealthCarePlus premiums. Costs within the country of exchange only are eligible.
I am retiring/changing schools/taking a break from work, can I still have cover?
You can retain your plans even if you retire, change occupations or cancel your union membership. If no longer a union member you will move to non-union member rates (approx. 10% higher). However, if you retire and stay a union member there will be no change to your HealthCarePlus subscription rates. Just remember to contact us ASAP as we may need to amend your premium rate or set up a new payment method if you previously paid via salary deduction.
How do I cancel my policy?
By writing to: UniMed, PO Box 1721, Christchurch 8140. By email to: email@example.com. Please talk to your HealthCarePlus Representative first or call 0800 268 3763 to discuss your options.
Where can I find competition terms and conditions?
To view competition terms and conditions, please click here