OrbitPay Card Medical Provider Terms & Conditions

Terms of use | Medical Providers Accepting OrbitPay Cards

In this document, ‘we’ and ‘us’ refers to OrbitProtect Limited. ‘Card’ refers to the OrbitProtect OrbitPay swipe card. In activating an eftpos terminal, you agree to the following terms of use:

You will confirm that the identity of the person holding the Card matches the name on that Card by checking a piece of identification e.g. drivers’ license or passport.
You will only allow treatment for the person named on the card to be put through on the Card
You will only put items on a card that meet the requirements stated in the ‘what is covered’ section below.
If you are a GP, for all GP consultations where a Card is used for payment or where you intend to invoice OrbitProtect directly, you will ensure the person signs a completed medical release form, allowing you to release the medical information to OrbitProtect.
You will provide invoices in accordance with IRD requirements, and you will keep a record of all invoices for 7 years or as required by regulation. You will provide us copies of invoices upon request.
You will let us know if you get any new eftpos terminals, so that we can ensure they are activated.
You will tell us if your email address changes, so we can continue to contact you with important information, like updates to these terms or the remittance advice for the terminals.
Either one of us can end this arrangement on 30 days’ notice to the other party.

On a monthly basis, we will email you a summary of all card transactions over $150 that went through your eftpos terminal/s. Once you have cross-referenced these transactions and entered your invoice numbers into the summary, you will need to email it back to us in the same Excel format. We will then arrange payment to you by direct credit on or about the 20th of the following month. For transactions under $150, you will only need to provide invoice numbers if we ask for them. If we do not ask for invoice information, those transactions will be paid on or about the 20th of the following month. Use of the swipe card supporting this process does not signify acceptance of a policyholder claim. Each medical condition is considered on its merit and is subject to the terms, conditions and limitations of the policy wording. You are welcome to advise the policyholder of this. To find out more or contact us with any questions, please call OrbitProtect on 0800 478 833 or email [email protected]

What is covered?

RSE and Seasonal Workers

We only cover the costs for treatment and items listed in the ‘what we cover’ section of this table. Anything else is excluded and can’t be put on the card. In situations where expenses are incurred but fall outside the cover we reserve the right to decline reimbursement or request reimbursement from the policyholder, at our discretion. When in doubt, please ask the cardholder to pay and send the claim to us.

Dental

What we cover

Up to $350 for the reasonable emergency dental treatment costs to sound and natural teeth, performed by a dentist providing these costs are incurred due to seeking treatment for:
a. relief from sudden and acute pain by the application of antibiotics, temporary dressing (being dressings intended to last about six to eight weeks) or extraction, or

b. injury to teeth. If the injury is covered by ACC (Accident Compensation Corporation) the limit is increased to $1,500

Please put ACC number on invoices where they relate to an injury

Specific things we don’t cover

We do not pay for the extraction of:
wisdom teeth
baby teeth (primary teeth)
We don’t pay for routine dental care, for example check-up appointments

a pre-existing medical condition
If the dental consultation or treatment is a result of the patient being under the influence of alcohol or non-prescribed drugs

GP

What we cover

GP consultation costs unless they relate to one of the excluded matters (see next column)

Please put ACC number on invoices where they relate to an injury

Specific things we don’t cover

a medical condition that commenced prior to the start date or
after the end date of the policyholder’s insurance plan
a pre-existing medical condition
sexually transmitted disease
contraception/sexual health
pregnancy, unless as a result of unexpected serious medical complication before the 21st week of pregnancy
immigration screening
a medical check-up or precautionary medicine including screening
If the medical consultation or treatment is a result of the patient being under the influence of alcohol or non-prescribed drugs

Lab tests

What we cover

Diagnostic lab tests up to $150 that have been ordered by a General Practitioner

Specific things we don’t cover

a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan
a pre-existing medical condition
sexually transmitted disease
contraception/sexual health
pregnancy, unless as a result of unexpected serious medical complication before the 21st week of pregnancy
immigration screening
a medical check-up or precautionary medicine including screening

Physiotherapy

What we cover

ACC accepted physiotherapy treatment only

Physiotherapy treatment unless it relates to one of the excluded matters (see next column)

Please put ACC number on invoices where they relate to an injury

Specific things we don’t cover

a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan
a pre-existing medical condition
If the treatment is a result of the patient being under the influence of alcohol or non-prescribed drugs
a check-up or precautionary treatment

Type	What we cover	Specific things we don’t cover
Dental	Up to $350 for the reasonable emergency dental treatment costs to sound and natural teeth, performed by a dentist providing these costs are incurred due to seeking treatment for: a. relief from sudden and acute pain by the application of antibiotics, temporary dressing (being dressings intended to last about six to eight weeks) or extraction, or b. injury to teeth. If the injury is covered by ACC (Accident Compensation Corporation) the limit is increased to $1,500 Please put ACC number on invoices where they relate to an injury	We do not pay for the extraction of: wisdom teeth baby teeth (primary teeth) We don’t pay for routine dental care, for example check-up appointments a pre-existing medical condition If the dental consultation or treatment is a result of the patient being under the influence of alcohol or non-prescribed drugs
GP	GP consultation costs unless they relate to one of the excluded matters (see next column) Please put ACC number on invoices where they relate to an injury	a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan a pre-existing medical condition sexually transmitted disease contraception/sexual health pregnancy, unless as a result of unexpected serious medical complication before the 21st week of pregnancy immigration screening a medical check-up or precautionary medicine including screening If the medical consultation or treatment is a result of the patient being under the influence of alcohol or non-prescribed drugs
Physiotherapy	ACC accepted physiotherapy treatment only Physiotherapy treatment unless it relates to one of the excluded matters (see next column) Please put ACC number on invoices where they relate to an injury	a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan a pre-existing medical condition If the treatment is a result of the patient being under the influence of alcohol or non-prescribed drugs a check-up or precautionary treatment
Lab tests	Diagnostic lab tests up to $150 that have been ordered by a General Practitioner	a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan a pre-existing medical condition sexually transmitted disease contraception/sexual health pregnancy, unless as a result of unexpected serious medical complication before the 21st week of pregnancy immigration screening a medical check-up or precautionary medicine including screening

Important terms used in the table above

Pre-existing medical conditions can be any one of the following: A medical or physical condition or circumstance that exists prior to the period of insurance In respect of which:

you (the policyholder) or the person concerned is aware of, or ought to have been aware of; or
advice, care, treatment, medication or medical attention has been sought, given, or recommended; or
have been diagnosed or indicative of a medical condition; or
are of such a nature to require, or which potentially may require medical attention; or
are of such a nature as would have caused a prudent, reasonable person to seek medical attention.

Start date means the date the insurance cover begins. It marks the beginning of the period during which the policyholder is protected by the insurance policy. From the start date, the policyholder can typically make claims and use the benefits and cover in the policy. To find out if a condition existed before the member’s start date, you’ll need to ask them or us when their policy started. End date means the date the insurance cover terminates or expires. It marks the end of the period during which the policyholder is protected by the insurance policy. After the end date, the policyholder will no longer have cover under the policy unless they choose to renew or extend it, subject to the terms and conditions. If a member’s policy has ended, their card will decline when they use it. Pharmacies: Over-the-counter medicines limits (for RSE Protect and Seasonal Worker policy ONLY) We can update this table by giving pharmacies 7 days’ notice.

Cold / Flu	$40
Cold Sores	$25
Constipation / Haemorrhoids	$30
Diarrhoea / Vomiting	$35
Dermatitis / Eczema / Rash	$35
Eyes: – Allergy/Bacterial Conjunctivitis	$25
Flea Bites / Stings	$35
Fungal Infections	$35
Hayfever	$40
Head Lice	$25
Scabies	$30
Urinary Tract Infections	$45
Vaginal Thrush	$35
Antiseptic Cream	$20
Indigestion / Heartburn	$35

Condition / Symptoms IMPORTANT: Ibuprofen and Paracetamol can only be provided by prescription.	Treatment limit (includes GST)
Cold / Flu	$40
Cold Sores	$25
Constipation / Haemorrhoids	$30
Diarrhoea / Vomiting	$35
Dermatitis / Eczema / Rash	$35
Eyes: – Allergy/Bacterial Conjunctivitis	$25
Flea Bites / Stings	$35
Fungal Infections	$35
Hayfever	$40
Head Lice	$25
Scabies	$30
Urinary Tract Infections	$45
Vaginal Thrush	$35
Antiseptic Cream	$20
Indigestion / Heartburn	$35

What is Covered?

International Students

Type
GP

What we cover
GP consultation costs unless they relate to one of the excluded matters (see next column)

Please put ACC number on invoices where they relate to an injury

Specific things we dont cover

a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan
a pre-existing medical condition
sexually transmitted disease
contraception/sexual health
Pregnancy, unless as a result of unexpected serious medical complication before the 21st week of pregnancy
immigration screening
a medical check-up or precautionary medicine including screening
If the medical consultation or treatment is a result of the patient being under the influence of alcohol or non-prescribed drugs

Type
Pharmacy

What we cover
Prescription costs only

Please put ACC number on prescriptions where they relate to an injury

Specific things we don’t cover

a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan
a pre-existing medical condition
sexually transmitted disease
contraception/sexual health
immigration screening
a medical check-up or precautionary medicine
Vitamins and/or other health supplements unless prescribed by a doctor
Medication for the use of cosmetic treatment

Type	What we cover	Specific things we don’t cover
GP	GP consultation costs unless they relate to one of the excluded matters (see next column) Please put ACC number on invoices where they relate to an injury	a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan a pre-existing medical condition sexually transmitted disease contraception/sexual health Pregnancy, unless as a result of unexpected serious medical complication before the 21st week of pregnancy immigration screening a medical check-up or precautionary medicine including screening If the medical consultation or treatment is a result of the patient being under the influence of alcohol or non-prescribed drugs
Pharmacy	Prescription costs only Please put ACC number on prescriptions where they relate to an injury	a medical condition that commenced prior to the start date or after the end date of the policyholder’s insurance plan a pre-existing medical condition sexually transmitted disease contraception/sexual health immigration screening a medical check-up or precautionary medicine Vitamins and/or other health supplements unless prescribed by a doctor Medication for the use of cosmetic treatment

Important terms used in the table above

Pre-existing medical condition means any of the following:

a physical defect, medical condition or disease for which treatment (including medication) or professional advice of any kind (from a medical adviser or other adviser) has been received or prescribed in the six months before the policy starts, and/or
an ongoing medical condition or disability that exists when the policy starts.

In respect to you only, any medical condition, disease or disability not otherwise excluded that we would consider to be a pre-existing medical condition that developed during the currency of a previous OrbitProtect Prime or Lite policy is automatically insured under this policy provided there is unbroken OrbitProtect coverage from the date the condition, disease or disability developed. Start date means the date the insurance cover begins. It marks the beginning of the period during which the policyholder is protected by the insurance policy. From the start date, the policyholder can typically make claims and use the benefits and cover in the policy. To find out if a condition existed before the member’s start date, you’ll need to ask them or us when their policy started. End date means the date the insurance cover terminates or expires. It marks the end of the period during which the policyholder is protected by the insurance policy. After the end date, the policyholder will no longer have cover under the policy unless they choose to renew or extend it, subject to the terms and conditions. If a member’s policy has ended, their card will decline when they use it.