Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Regulations 1999

  • revoked
  • Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Regulations 1999: revoked, on 1 April 2004, by regulation 20(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388).

Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Regulations 1999

(SR 1999/104)

  • Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Regulations 1999: revoked, on 1 April 2004, by regulation 20(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388).


Note

These regulations are administered in the Department of Labour.


PURSUANT to section 402 of the Accident Insurance Act 1998, His Excellency the Governor-General, acting by and with the advice and consent of the Executive Council, makes the following regulations.

1 Title and commencement
  • (1) These regulations may be cited as the Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Regulations 1999.

    (2) These regulations come into force on 1 July 1999.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

2 Interpretation
  • In these regulations, unless the context otherwise requires,—

    The Act means the Accident Insurance Act 1998

    Ambulance

    [Revoked]

    Ambulance: this definition was revoked, as from 1 April 2002, by regulation 20(a) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

    Ambulance operator

    [Revoked]

    Ambulance operator: this definition was revoked, as from 1 April 2002, by regulation 20(a) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

    Elective surgery

    • (a) Means any surgery required in respect of a personal injury; but

    • (b) Does not include—

      • (i) An acute treatment; or

      • (ii) A public health acute service; or

      • (iii) Treatment:

    Emergency overseas transport

    [Revoked]

    Emergency overseas transport: this definition was revoked, as from 1 April 2002, by regulation 20(a) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

    Emergency transport

    [Revoked]

    Emergency transport: this definition was revoked, as from 1 April 2002, by regulation 20(a) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

    Emergency transport by air

    [Revoked]

    Emergency transport by air: this definition was revoked, as from 1 April 2002, by regulation 20(a) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

    Insurer has the meaning given to it by section 75 of the Act

    Overseas treatment

    [Revoked]

    Overseas treatment: this definition was revoked, as from 1 April 2002, by regulation 20(a) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

    Radiologist means a medical practitioner who holds a licence, appropriate to the treatment for which payment is sought, under the Radiation Protection Act 1965

    Radiologist: this definition was amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by omitting the word registered.

    Recognised branch of medicine means any of the following branches of medicine

    • (a) Anaesthetics:

    • (b) Cardiothoracic Surgery:

    • (c) Dermatology:

    • (d) Diagnostic Radiology:

    • (e) Emergency Medicine:

    • (f) General Surgery:

    • (g) Internal Medicine:

    • (h) Neurosurgery:

    • (i) Obstetrics and Gynaecology:

    • (j) Occupational Medicine:

    • (k) Ophthalmology:

    • (l) Orthopaedic Surgery:

    • (m) Otolaryngology Head and Neck Surgery:

    • (n) Paediatric Surgery:

    • (o) Paediatrics:

    • (p) Pathology:

    • (q) Plastic and Reconstructive Surgery:

    • (r) Psychological Medicine or Psychiatry:

    • (s) Public Health Medicine:

    • (t) Radiation Oncology:

    • (u) Rehabilitation Medicine:

    • (v) Sexual Health Medicine:

    • (w) Urology:

    • (x) Venereology:

    Recognised branch of medicine: this definition was inserted, as from 15 October 1999, by regulation 2(1) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352).

    Recognised branch of medicine: this definition was substituted, as from 11 November 1999, by regulation 2(2) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352).

    registered specialist means a medical practitioner whose scope of practice includes at least 1 recognised branch of medicine.

    Registered specialist: this definition was substituted, as from 15 October 1999, by regulation 2(1) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352).

    Registered specialist: this definition was substituted, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48).

    scope of practice has the same meaning as in section 5(1) of the Health Practitioners Competence Assurance Act 2003.

    scope of practice: this definition was inserted, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48).

    Specified treatment provider means an acupuncturist, chiropractor, occupational therapist, osteopath, physiotherapist, podiatrist, or speech therapist

    Treatment means a treatment specified in the Schedule

    Vocational registration.

    [Revoked]

    Vocational registration: this definition was revoked, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48).

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

3 What hourly rate means
  • (1) When an hourly rate is specified in these regulations (except regulation 10(5)(b)), the insurer is liable to pay appropriate proportions for part of an hour.

    (2) Under regulation 10(5)(b), the insurer is liable to pay appropriate proportions for part of an hour after the first 30 minutes.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

Insurer's liability to pay cost of treatment

4 Liability of insurer, except manager, to pay cost of treatment or ancillary service
  • (1) The amount that an insurer, except the manager, is liable to pay under clause 1(2)(b) of Schedule 1 of the Act for treatment other than elective surgery is calculated by—

    • (a) Determining the amount that the treatment provider who treated the insured for a personal injury charges for treating personal injuries of the kind suffered by the insured; and

    • (b) Determining the amount that is payable under these regulations; and

    • (c) Selecting the lesser of the amounts determined under paragraphs (a) and (b).

    (2) For the purposes of subclause (1)(b), the amounts that are payable under these regulations are in—

    • (a) Column 2 of the Schedule, which specifies the amount payable for the treatment, opposite the amount, in column 1 of the Schedule; and

    • (b) Regulations 6 to 12, some of which prescribe amounts that are payable without reference to the Schedule and others of which modify the amounts specified in the Schedule.

    (3) The amount that an insurer, except the manager, is liable to pay under clause 1(2)(b) of Schedule 1 of the Act for elective surgery is calculated under regulation 13.

    (4) [Revoked]

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Regulation 4 was substituted, as from 1 July 1999, by regulation 2 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 1999 (SR 1999/192).

    Subclause (4) was revoked, as from 1 April 2002, by regulation 20(b) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

4A Liability of manager to pay cost of treatment
  • (1) The amount that the manager is liable to pay under clause 1(2)(b) of Schedule 1 of the Act for treatment other than elective surgery is,—

    • (a) If the manager has not made a contract that deals with the kind of treatment given to the insured by the treatment provider, the amount calculated under subclause (3):

    • (b) If the manager has made a contract that deals with the kind of treatment given to the insured by the treatment provider, the amount calculated under subclause (4).

    (2) For the purposes of subclauses (3)(b) and (4)(b), the amounts that are payable under these regulations are in—

    • (a) Column 2 of the Schedule, which specifies the amount payable for the treatment, opposite the amount, in column 1 of the Schedule; and

    • (b) Regulations 6 to 12, some of which prescribe amounts that are payable without reference to the Schedule and others of which modify the amounts specified in the Schedule.

    (3) For the purposes of subclause (1)(a), the amount is calculated by—

    • (a) Determining the amount that the treatment provider who treated the insured for a personal injury charges for treating personal injuries of the kind suffered by the insured; and

    • (b) Determining the amount that is payable under these regulations; and

    • (c) Selecting the lesser of the amounts determined under paragraphs (a) and (b).

    (4) For the purposes of subclause (1)(b), the amount is calculated by—

    • (a) Determining the amount that the treatment provider who treated the insured for a personal injury charges for treating personal injuries of the kind suffered by the insured; and

    • (b) Determining the amount that the manager is liable to pay under payment method A, that is, payment under these regulations; and

    • (c) Determining the amount that the manager is liable to pay under payment method B, that is, payment under the contract. (To avoid any doubt, nothing in regulations 6 to 12 or the Schedule applies to treatment to which such a contract applies); and

    • (d) Determining—

      • (i) Whether the insured would be liable to pay anything to the treatment provider if payment method A were used and, if so, how much; and

      • (ii) Whether the insured would be liable to pay anything to the treatment provider if payment method B were used and, if so, how much; and

    • (e) If the insured would be liable to pay something to the treatment provider under either payment method A or payment method B, selecting whichever payment method results in the insured being liable to pay the least to the treatment provider; and

    • (f) If the insured would not be liable to pay anything to the treatment provider under either payment method A or payment method B, selecting payment method B.

    (5) The amount that the manager is liable to pay under clause 1(2)(b) of Schedule 1 of the Act for elective surgery is calculated under regulation 13.

    (6) The power of the manager to make, under section 329 of the Act, contracts of the kind referred to in subclause (1)(b) is affected by section 339 of the Act, as to both the ability to enter into the contract and the contents of the contract.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Regulations 4A and 4B were inserted, as from 1 July 1999, by regulation 2 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 1999 (SR 1999/192).

4B Liability of manager to pay cost of ancillary service
  • [Revoked]

    Regulations 4A and 4B were inserted, as from 1 July 1999, by regulation 2 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 1999 (SR 1999/192).

    Regulation 4B was revoked, as from 1 April 2002, by regulation 20(b) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

5 Insurer not liable to pay cost of public health acute service
  • (1) An insurer is not liable to pay anything to the insured for a public health acute service that—

    • (a) The insured receives; or

    • (b) The insured does not receive but is entitled to receive.

    (2) Subclause (1) applies even though the public health acute service is—

    • (a) A treatment of a kind to which regulation 4 or regulation 4A applies; or

    • (b) Elective surgery of a kind to which regulation 4 or regulation 4A applies; or

    • (c) [Revoked]

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Subclause (2)(a) was amended, as from 1 July 1999, by regulation 3(a) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 1999 (SR 1999/192) by inserting the expression or regulation 4A.

    Subclause (2)(b) was amended, as from 1 July 1999, by regulation 3(b) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 1999 (SR 1999/192) by inserting the expression or regulation 4A.

    Subclause (2)(c) was amended, as from 1 July 1999, by regulation 3(c) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 1999 (SR 1999/192) by inserting the expression or regulation 4B.

    Subclause 2(c) was revoked, as from 1 April 2002, by regulation 20(b) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

Treatment providers' costs

6 Counsellors' costs
  • (1) This regulation relates to the treatments under the heading Counsellors' Costs.

    (2) The insurer is liable to pay $78.75 an hour for the treatment described in item 5 of the Schedule.

    (3) The insurer is liable to pay $56.25 an hour for the treatment described in item 6 of the Schedule.

    (4) The insurer is liable to pay only the rate specified in this regulation, no matter how many people the counsellor treats in the session for which payment is sought.

    (5) The insurer is liable to pay only for counselling provided on a face-to-face basis. This subclause is subject to subclause (6).

    (6) The insurer is liable to pay for 1 session of counselling provided on other than a face-to-face basis if the counselling is provided because the insured needs it urgently for a mental injury the insured suffered in the circumstances described in section 40 of the Act.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Subclauses (5) and (6) were inserted, as from 1 July 1999, by regulation 4 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 1999 (SR 1999/192).

7 Dentists' costs
  • (1) This regulation relates to the treatments under the heading Dentists' Costs.

    (2) If the insured is given both a treatment and a more comprehensive treatment at the same visit, the insurer is liable to pay only the cost of the more comprehensive treatment.

    (3) If the insured is given an implant, the insurer is liable to pay the amount specified in the Schedule for whichever of the following would otherwise have been given:

    • (a) Crown:

    • (b) Bridge:

    • (c) Metal denture.

    (4) If an insured is given a treatment on a tooth that has previously been heavily restored, and no insurer was liable to pay for the previous restoration, the insurer is liable to pay 75% of the amount specified in the Schedule for the treatment.

    (5) If an insured is given a treatment on a tooth that has previously been crowned, and no insurer was liable to pay for the previous crowning, the insurer is liable to pay 50% of the amount specified in the Schedule for the treatment.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Subclause (4) was amended, as from 15 October 1999, by regulation 3 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352) by substituting the expression 75% for the expression 25%.

8 Hyperbaric oxygen treatment costs
  • (1) This regulation relates to the treatments under the heading Hyperbaric Oxygen Treatment Costs.

    (2) If the insured is given such a treatment, the insurer is liable to pay—

    • (a) $57.40 an hour for the use of a hyperbaric oxygen chamber; and

    • (b) The amount specified in the Schedule for the treatment.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

9 Radiologists' costs
  • (1) This regulation relates to the treatments under the heading Radiologists' Costs.

    (2) If the insured is given a treatment by a radiologist whose scope of practice does not include the branch of medicine known as diagnostic radiology, the insurer is liable to pay 60% of the amount specified in the Schedule for the treatment.

    (3) If the insured is given a treatment by a radiologist whose scope of practice includes the branch of medicine known as diagnostic radiology, the insurer is liable to pay the amount specified in the Schedule for the treatment.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Subclause (2) was amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by substituting the words whose scope of practice does not include for the words who does not hold vocational registration in.

    Subclause (3) was amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by substituting the words whose scope of practice includes for the words who holds vocational registration in.

10  medical practitioners' costs
  • (1) This regulation relates to the treatments under the heading Medical Practitioners' Costs.

    (1A) This regulation applies if the insured visits, or is visited by, a medical practitioner who either—

    • (a) is not a registered specialist; or

    • (b) is a registered specialist but, during the consultation, is not practising within a recognised branch of medicine that is included in his or her scope of practice.

    (2) If this regulation applies, the insurer is liable to pay—

    • (a) The following rates for each consultation that the insured has:

      • (i) $35.00, if the insured is under 6 years when the consultation takes place:

      • (ii) $26.00, if the insured is 6 years or over when the consultation takes place; and

    • (b) The amount specified in the Schedule for any treatment the insured is given.

    (3) If the insured is given both a treatment and a more comprehensive treatment at the same visit, the insurer is liable to pay only the cost of the more comprehensive treatment.

    (4) If the insured is given 2 or more separate treatments at the same visit, the insurer is liable to pay—

    • (a) The amount specified in the Schedule for the more or most expensive treatment the insured is given; and

    • (b) 50% of the amount specified in the Schedule for each other treatment the insured is given.

    (5) If a medical practitioner referred to in subclause (1A) travels to an insured and gives him or her emergency treatment, the insurer is liable to pay—

    • (b) $47.80 an hour for any part of the emergency consultation that exceeds 30 minutes, if the insurer is liable to pay a travelling fee under paragraph (a); and

    • (c) The amount payable under subclause (2).

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    The heading to regulation 10 was amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by omitting the word registered.

    Subclause (1) was amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by omitting the word registered.

    Subclause (1A) was inserted, as from 15 October 1999, by regulation 4(1) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352).

    Subclause (1A) was substituted, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48).

    Subclause (2) was amended, as from 15 October 1999, by regulation 4(2) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352) by substituting the words If this regulation applies, for the words If the insured visits, or is visited by, a registered medical practitioner,.

    Subclause (2)(a)(i) was amended, as from 1 July 2002, by regulation 3 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 2002 (SR 2002/186) by substituting the expression $35.00 for the expression $32.50.

    Subclause (5) was amended, as from 15 October 1999, by regulation 4(3) Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352) by inserting the words referred to in subclause (1A).

    Subclause (5)(a) was amended, as from 1 January 2001, by section 111(2) New Zealand Public Health and Disability Act 2000 (2000 No 91) by substituting the words if the cost of travel in the same circumstances is payable under the New Zealand Public Health and Disability Act 2000 for the words if a funder would be liable to pay for travel in the same circumstances.

    Subclause (5) was amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by omitting the word registered.

10A Registered specialists' costs
  • (1) This regulation relates to the treatments under the heading Registered Specialists' Costs.

    (2) This regulation applies if the insured visits, or is visited by, a medical practitioner who—

    • (a) is a registered specialist; and

    • (b) during the consultation, is practising within a recognised branch of medicine that is included in his or her scope of practice.

    (3) If this regulation applies, the insurer is liable to pay—

    • (a) The following rate for a first consultation that the insured has:

      • (i) $97.55, if the consultation was with a registered specialist who, during the consultation, was practising within any of the following recognised branches of medicine:

        • (A) Internal Medicine:

        • (B) Neurosurgery:

        • (C) Occupational Medicine:

        • (D) Paediatrics:

        • (E) Psychological Medicine or Psychiatry:

        • (F) Rehabilitation Medicine; or

      • (ii) $76.50, if the consultation was with a registered specialist who, during the consultation, was practising within any other recognised branch of medicine; and

    • (b) $38.25, for any later consultation that the insured has with a registered specialist; and

    • (c) The amount specified in the Schedule for any treatment the insured is given.

    (4) If the insured is given both a treatment and a more comprehensive treatment at the same visit, the insurer is liable to pay only the cost of the more comprehensive treatment.

    (5) If the insured is given 2 or more separate treatments at the same visit, the insurer is liable to pay—

    • (a) The amount specified in the Schedule for the more or most expensive treatment the insured is given; and

    • (b) 50% of the amount specified in the Schedule for each other treatment the insured is given.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Regulation 10A was inserted, as from 15 October 1999, by regulation 5 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352).

    Subclause (2) was substituted, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48).

11 Specified treatment providers' costs
  • (1) This regulation relates to the treatments under the heading Specified Treatment Providers' Costs.

    (2) A specified treatment provider may elect not to be paid the amount specified in item 249 of the Schedule for any treatments that he or she gives any insured.

    (3) The specified treatment provider must then give the insurer a written notice of election.

    (4) The specified treatment provider may revoke such an election by giving the insurer a written notice of revocation but may then give another written notice of election only if the insurer first gives written consent.

    (5) An insurer that receives a written notice of election is liable to pay the cost of the treatment given by the specified treatment provider at the lesser of—

    • (a) The rate of $47.80 an hour; or

    • (b) The rate the specified treatment provider would have charged the insured if the insurer were not to pay the cost.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Subclause (2) was amended, as from 15 October 1999, by regulation 6 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352) by substituting the expression 249 for the expression 206.

12 Nurses' costs
  • (1) In this regulation, nurse means a nurse working in a general practice to which the practice nurse subsidy is payable under terms and conditions agreed under the New Zealand Public Health and Disability Act 2000.

    (2) If the insured visits, or is visited by, a nurse, the insurer is liable to pay—

    • (a) $11.00 an hour for each consultation that the insured has; and

    • (b) The amount specified in the Schedule for any treatment the nurse gives the insured and that could be given by a medical practitioner.

    (3) If the insured is given both a treatment and a more comprehensive treatment at the same visit, the insurer is liable to pay only the cost of the more comprehensive treatment.

    (4) If the insured is given 2 or more separate treatments at the same visit, the insurer is liable to pay—

    • (a) the amount specified in the Schedule for the more or most expensive treatment the insured is given; and

    • (b) 50% of the amount specified in the Schedule for each other treatment the insured is given.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Subclause (1) was amended, as from 1 January 2001, by section 111(2) New Zealand Public Health and Disability Act 2000 (2000 No 91) by substituting the words agreed under the New Zealand Public Health and Disability Act 2000 for the words applying between the funder and the practice.

    Subclause (2)(b) was amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by omitting the word registered.

    Subclauses (3) and (4) were inserted, as from 10 January 2002, by regulation 3 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 2001 (SR 2001/387).

13 Elective surgery costs
  • (1) In this regulation,—

    Chosen provider means the provider chosen by the insured under subclause (4)(b) or (c)

    Nominated provider means the provider nominated by the insurer under subclause (3)

    Provider means a provider of elective surgery, and includes a district health board.

    Subclause (1) Provider: this definition was amended, as from 1 January 2001, by section 111(2) New Zealand Public Health and Disability Act 2000 (2000 No 91) by substituting the words district health board for the words hospital and health service.

    (2) This regulation applies if an insurer is liable to pay for elective surgery for the insured.

    (3) The insurer may nominate a provider to perform the insured's elective surgery.

    (4) The insured does 1 of the following:

    • (a) Decides to accept the nominated provider:

    • (b) Decides not to accept the nominated provider and to choose a provider:

    • (c) Chooses a provider, if the insurer does not nominate a provider.

    (5) Before the insured decides whether to accept the nominated provider, the insurer must tell the insured the amount that the insurer would be liable to pay if the surgery were performed by the nominated provider.

    (6) The insurer is liable to pay the full cost of the surgery if it is performed by—

    • (a) A district health board, whether it is the chosen provider or the nominated provider; or

    • (b) The nominated provider; or

    • (c) The chosen provider, if the insurer does not nominate a provider.

    (7) The insurer is liable to pay 60% of the amount that would have been payable had the surgery been performed by the nominated provider, if—

    • (a) The insurer nominated a provider; and

    • (b) The surgery is performed by the chosen provider; and

    • (c) The chosen provider is not a district health board.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

    Subclause (6)(a) was amended, as from 1 January 2001, by section 111(2) New Zealand Public Health and Disability Act 2000 (2000 No 91) by substituting the words district health board for the words hospital and health service.

    Subclause (7)(c) was amended, as from 1 January 2001, by section 111(2) New Zealand Public Health and Disability Act 2000 (2000 No 91) by substituting the words district health board for the words hospital and health service.

Emergency transport in New Zealand

  • The heading Emergency Transport in New Zealand was revoked, as from 1 April 2002, by regulation 20(c) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

14 Emergency transport costs
  • [Revoked]

    Subclause (2) was amended, as from 1 January 2001, by section 111(2) New Zealand Public Health and Disability Act 2000 (2000 No 91) by substituting the words or the district health board for the words , the funder, or the licensed hospital, in both places where they appear.

    Regulations 14 to 18 were revoked, as from 1 April 2002, by regulation 20(b) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

15 Non-emergency transport costs
  • [Revoked]

    Regulations 14 to 18 were revoked, as from 1 April 2002, by regulation 20(b) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

16 Escort costs
  • [Revoked]

    Regulations 14 to 18 were revoked, as from 1 April 2002, by regulation 20(b) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

17 Accommodation costs
  • [Revoked]

    Regulations 14 to 18 were revoked, as from 1 April 2002, by regulation 20(b) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

Emergency overseas treatment and transport

  • The heading Emergency Overseas Treatment and Transport was revoked, as from 1 April 2002, by regulation 20(c) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

18 Emergency overseas treatment and transport costs
  • [Revoked]

    Regulations 14 to 18 were revoked, as from 1 April 2002, by regulation 20(b) Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002 (SR 2002/13).

Goods and services tax

19 Goods and services tax
  • All amounts specified or referred to in these regulations are inclusive of goods and services tax.

    These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.


Schedule
Costs of treatment

Reg 4

  • These Regulations were revoked, as from 1 April 2004, by regulation 20(1) Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388). See regulation 20(2) of those Regulations as to the saving provision.

 $
AUDIOLOGISTS' COSTS 
1.Consultation...................................................................
19.15
2.Pure-tone audiometry...................................................................
47.80
3.Impedance tympanometry...................................................................
38.25
4.Brain-stem evoked response (brain-damaged persons only)...................................................................
66.95
COUNSELLORS' COSTS 
5.Consultation provided by a counsellor who is registered specialist—see regulation 6(2) 
6.Consultation provided by a counsellor—see regulation 6(3) 
DENTISTS' COSTS 
7.Examination and assessment...................................................................
31.60
8.Examination and assessment by a dentist whose scope of practice includes a dental speciality recognised by the Dental Council working in his or her speciality...................................................................
66.95
X-rays 
9.Periapical or bitewing film, each...................................................................
7.65
10.Occlusal, each...................................................................
19.15
11.Panorex...................................................................
33.50
12.Lateral postero—anterior jaws or head, occipito-mental...................................................................
43.05
13.Lateral oblique of mandible...................................................................
43.05
14.Emergency temporary cover...................................................................
19.15
Extractions (non-orthodontic only) 
15.First permanent tooth or deciduous quadrant, with local anaesthetic...................................................................
47.80
16.First permanent tooth or deciduous quadrant, with general anaesthetic...................................................................
66.95
17.Each succeeding permanent tooth (maximum 4 teeth) or deciduous quadrant...................................................................
18.20
18.Single jaw clearance, 6 teeth or more...................................................................
86.05
19.Full clearance, both jaws 12 teeth or more...................................................................
153.00
20.Surgical extraction of impacted third molars or other impacted teeth—single...................................................................
95.65
 —double...................................................................
143.45
Non-metallic fillings 
21.Simple fillings in anterior teeth and buccal surfaces of premolars...................................................................
37.30
22.More than 1 surface in anterior teeth, per tooth...................................................................
56.45
Amalgam fillings 
23.One surface (including 2 filings on occlusal surface of upper molars, including all buccal, palatal, and lingual fissure extensions)...................................................................
31.60
24.Two-surface (approximo-occlusal)...................................................................
42.10
25.Three-surface (mesio-occlusal-distal)...................................................................
47.80
26.Restoration (including restoration of 1 or more cusps)...................................................................
67.90
Pulp and root canal treatment 
27.Partial pulpectomy...................................................................
57.40
28.Septic root canal treatment and root filling, permanent teeth (per canal)...................................................................
136.75
29.Apicectomy and retrograde amalgam...................................................................
144.40
30.Bleaching...................................................................
56.45
Prosthetic appliances 
 Partial dentures 
31.1 tooth, acrylic...................................................................
209.45
32.Each extra tooth...................................................................
12.45
33.Each clasp...................................................................
7.65
34.Lingual bar...................................................................
13.40
35.1 tooth, metal (vitallium)...................................................................
515.45
36.Each extra tooth...................................................................
12.45
 Full dentures 
37.Full upper or lower...................................................................
382.50
38.Full upper and lower...................................................................
669.40
39.Rebasing full upper or lower...................................................................
153.00
40.Replacing 1 broken tooth when remaking or rebasing...................................................................
32.50
41.Each extra tooth...................................................................
9.55
42.Repairs...................................................................
34.45
Splints and bands (non-orthodontic) 
43.Composite, per tooth (with/without wires)...................................................................
21.05
44.Wiring, per tooth...................................................................
16.30
45.Composite bonding metal brackets and arch wire, per tooth...................................................................
31.60
Crowns 
46.Stainless steel crown...................................................................
47.80
47.Plastic crown...................................................................
33.50
48.Acrylic—heat processed...................................................................
229.50
49.Composite crown...................................................................
88.95
50.Porcelain, including veneers and inceram type crown...................................................................
405.45
51.Porcelain baked to metal crown or full gold crown462.85
52.Gold or porcelain inlay—MI, DI, or incisal...................................................................
143.45
53.—MID...................................................................
215.20
54.—Facing for...................................................................
19.15
55.gold crown (anterior or posterior)...................................................................
286.90
56.Recement crown or inlay...................................................................
19.15
Post and cores 
57.Amalgam or composite resin core...................................................................
37.30
58.Metal—para post or similar...................................................................
55.45
59.Cast post—from impression, requiring a second appointment...................................................................
71.75
Bridges 
60.Standard, per unit...................................................................
382.50
61.Rochette, per unit...................................................................
141.55
62.Maryland, per unit...................................................................
176.95
63.Composite, complete bridge...................................................................
155.90
Surgery 
64.Minor oral surgical operations not otherwise covered by this schedule...................................................................
95.65
Soft tissues 
65.Lacerations—minor...................................................................
105.20
66.—moderate...................................................................
148.25
67.Drainage abscess, cellulitis...................................................................
129.10
68.Traumatic mucous cyst...................................................................
157.80
69.Removal of foreign bodies...................................................................
176.95
Bone 
70.Jaw fractures—conservative...................................................................
86.05
71.—simple with IMF...................................................................
196.05
Temporo-mandibular joint trauma 
72.Traumatic arthritis—conservative treatment...................................................................
110.00
73.—splints...................................................................
119.55
74.Oro-antral fistula—buccal sliding flap closure...................................................................
162.55
75.Removal of foreign bodies from soft tissues...................................................................
176.95
Teeth 
76.Removal of fractured tooth...................................................................
47.80
77.Removal of impacted teeth in line of jaw fracture167.35
78.Removal of teeth replaced into hard or soft tissue167.35
79.Apicectomy and rootfilling—anterior...................................................................
205.60
 —posterior...................................................................
253.45
Implants 
 See regulation 7(3) 
Emergency treatment 
80.Reposition single permanent tooth...................................................................
19.15
81.Each succeeding tooth...................................................................
4.85
HYBERBARIC OXYGEN TREATMENT COSTS 
82.Neurological assay before recompression...................................................................
95.65
83.Neurological assay after recompression...................................................................
86.05
84.In-chamber treatment supervision, per hour...................................................................
97.55
85.Out-of-chamber treatment supervision, per hour47.80
RADIOLOGISTS' COSTS 
Anatomical site 
Upper limb and shoulder girdle 
86.Sternum...................................................................
39.25
87.Sterno-clavicular joints...................................................................
39.25
88.Clavicle...................................................................
37.30
89.Acromio-clavicular joints...................................................................
37.30
90.Scapula...................................................................
37.30
91.Shoulder...................................................................
43.05
92.Humerus...................................................................
36.35
93.Elbow joint...................................................................
36.35
94.Forearm...................................................................
36.35
95.Hand or wrist joint or both...................................................................
35.45
96.Arthrogram...................................................................
119.55
97.Tomography, additional...................................................................
31.60
98.Upper limb (infant)...................................................................
37.30
Lower limb and pelvic girdle 
99.Sacro-iliac joints...................................................................
37.30
100.Pelvis...................................................................
42.10
101.Pelvis plus hip joint...................................................................
42.10
102.Pelvis or both hip joints or both pelvis and both hip joints...................................................................
44.00
103.Hip joint (2 projections)...................................................................
43.05
104.Femur...................................................................
43.05
105.Knee joint...................................................................
42.10
106.Knee joint plus intercondylar projection or axial projection...................................................................
43.05
107.Leg...................................................................
42.10
108.Angle joint...................................................................
42.10
109.Ankle joint plus projections in forced inversion or both or projections in forced eversion or both...................................................................
43.05
110.Foot...................................................................
35.45
111.Foot plus projection with weight bearing...................................................................
40.15
112.Arthrogram...................................................................
119.55
113.Tomography, additional...................................................................
31.60
114.Lower limb (infant)...................................................................
37.30
Spinal column 
115.Cervical spine...................................................................
50.70
116.Thoracic spine...................................................................
50.70
117.Lumbar spine plus lumbo-sacral joint...................................................................
53.55
118.Sacro-coccygeal spine...................................................................
50.70
119.Tomography, additional...................................................................
31.60
120.Lower thoracic and lumbar spine...................................................................
52.60
121.Cervical and upper thoracic spine...................................................................
52.60
122.Lumbar spine...................................................................
53.55
123.Lumbar spine and sacrum...................................................................
53.55
Respiratory system 
124.Nasal sinuses...................................................................
36.35
125.Naso-pharynx...................................................................
35.45
126.Larynx...................................................................
35.45
127.Thoracic inlet...................................................................
35.45
128.Chest (PA projection)...................................................................
31.60
129.Chest (with lateral projection)...................................................................
41.15
130.Thoracic cage...................................................................
38.25
131.AP tomography, additional...................................................................
38.25
132.Lateral tomography, additional...................................................................
38.25
Alimentary system 
133.Upper teeth...................................................................
36.35
134.Lower teeth...................................................................
36.35
135.Mandible...................................................................
45.00
136.Temporo-mandibular joints...................................................................
45.00
137.Abdomen (single projection)...................................................................
40.15
138.Abdomen (2 or more projections)...................................................................
48.80
139.Tomography, additional...................................................................
31.60
Renal system 
140.Plain renal...................................................................
40.15
141.Intravenous pyelogram...................................................................
92.80
142.Retrograde pyelogram...................................................................
96.60
143.Retrograde cystogram...................................................................
88.00
144.Micturating cysto-urethrogram...................................................................
96.60
145.Tomography, additional...................................................................
31.60
Nervous system 
146.Skull...................................................................
50.70
147.Nasal bones...................................................................
37.30
148.Facial bones...................................................................
48.80
149.Optic foramina...................................................................
46.90
150.Auditory canals...................................................................
37.30
151.Lumbar myelogram or radiculogram...................................................................
125.30
152.Lumbar and thoracic myelogram or radiculogram...................................................................
129.10
153.Lumbar, thoracic, and cervical myelogram or radiculogram...................................................................
138.70
154.Tomography, additional...................................................................
31.60
Ultrasound 
155.Gall bladder and upper abdomen...................................................................
39.25
156.Kidney and bladder...................................................................
88.00
157.Head...................................................................
76.50
158.Female pelvis...................................................................
38.25
159.Testis...................................................................
76.50
160.Foreign body localisation...................................................................
76.50
161.Musculo-skeletal injury (tendon, joint, or haematoma)...................................................................
76.50
Barium examinations (location of foreign body) 
162.Barium swallow...................................................................
52.60
163.Barium meal...................................................................
57.40
164.Barium follow through...................................................................
71.75
165.Barium enema...................................................................
95.65
Other 
166.Ascending urethrogram...................................................................
76.50
167.Mammogram...................................................................
57.40
168.Comparison view, opposite side...................................................................
14.40
169.Venogram, limb...................................................................
129.10
170.Contrast media, per 20 ml...................................................................
21.05
MEDICAL PRACTITIONERS' COSTS 
General 
171.Debride (including cleaning) wound (initial consultation only)...................................................................
23.95
172.Closure of wound up to 5 cm...................................................................
17.20
173.Closure of wound greater than 5 cm, but less than 10 cm...................................................................
26.80
174.Closure of wound 10 cm or more...................................................................
36.35
175.Set and plaster (including fibreglass)/splint fracture finger/toe...................................................................
19.15
176.Set and plaster (including fibreglass)/splint fracture wrist/arm...................................................................
114.75
177.Set and plaster (including fibreglass)/splint fracture ankle/leg...................................................................
162.55
178.Removal of foreign body from eye...................................................................
23.95
179.Insertion of IV line for transfusion...................................................................
57.40
180.Intra-articular, tendon sheath, intra-bursal, or epicondylar injection...................................................................
19.15
181.Incise, drain, and debride abscess or haematoma28.70
182.Amputation of digit (in emergency only)...................................................................
95.65
183.Endotracheal intubation...................................................................
95.65
184.Insert emergency chest tube...................................................................
26.80
185.Pinch skin graft...................................................................
71.75
186.Extensor tendon, primary repair...................................................................
172.15
187.Removal of foreign body from ear, other than by simply syringing...................................................................
23.95
188.Foreign body, exploration, and removal (other than eye or ear)...................................................................
28.70
189.Nail, simple removal of...................................................................
19.15
190.Nail, wedge resection of...................................................................
95.65
191.Aspiration of traumatic joint effusion/haemarthiosis14.35
192.Administration of activated charcoal to child following accidental ingestion...................................................................
19.15
Dislocations 
193.Finger/toe, with splint/strapping...................................................................
33.50
194.Thumb, with splint/strapping...................................................................
86.05
195.Shoulder, plus immobilisation...................................................................
57.40
196.Patella, with plaster, plus immobilisation...................................................................
81.30
197.Elbow/wrist, with plaster, plus immobilisation...................................................................
95.65
198.Hip, plus immobilisation...................................................................
114.75
Regional anaesthesia 
199.Axillary...................................................................
53.55
200.Digital...................................................................
26.80
201.Ischaemic arm block...................................................................
53.55
202.Dental...................................................................
26.80
Splinting for soft tissue injury 
203.Upper limb—above elbow...................................................................
71.75
204.—below elbow...................................................................
62.20
205.Lower limb—above knee...................................................................
86.05
 —below knee...................................................................
71.75
REGISTERED SPECIALISTS COSTS
Repair recent wound
206.Not exceeding 7 cm, superficial...................................................................
143.45
207.Not exceeding 7 cm, deeper tissue...................................................................
191.25
208.Exceeding 7 cm, superficial...................................................................
239.10
209.Exceeding 7 cm, deeper tissue...................................................................
286.90
Fractures (closed reduction)
210.Phlanges...................................................................
95.65
211.Metacarpals, excluding Bennetts...................................................................
172.15
212.Metatarsals...................................................................
133.90
213.Bennetts...................................................................
248.65
214.Carpal bones...................................................................
124.30
215.Colles...................................................................
229.50
216.Radius and ulna—shafts...................................................................
277.30
217.Radius—head and neck...................................................................
248.65
218.Humerus...................................................................
277.30
219.Talus—neck...................................................................
258.20
220.Calcaneus...................................................................
258.20
221.Other tarsals...................................................................
162.60
222.Ankle—fracture dislocation, Potts...................................................................
401.65
223.Tibia and fibula—shaft...................................................................
459.00
224.—upper end...................................................................
401.65
225.—involving joint traction...................................................................
468.55
226.—femur, any site, with/without traction...................................................................
707.65
Haematoma, abscess, or other infection
227.Small—aspiration...................................................................
23.95
228.Large—incision and drainage (local anaesthetic)...................................................................
114.15
229.incision and drainage (general anaesthetic)...................................................................
124.30
Foreign body, removal of
230.Under local anaesthetic...................................................................
90.90
231.Under general anaesthetic...................................................................
200.80
232.From cornea or scelera...................................................................
62.20
233.From ear, other than by simple syringing...................................................................
95.65
234.From muscle, tendon, or other deep tissue...................................................................
286.90
235.From nose, other than by simple probing...................................................................
114.75
236.From throat, additional fee...................................................................
95.65
Dislocations (closed reduction)
237.Elbow, wrist, thumb and fingers with strapping/splint...................................................................
191.25
238.Shoulder...................................................................
114.75
239.Patella...................................................................
162.60
240.Hip...................................................................
229.50
Plaster
241.Upper limb—above elbow...................................................................
143.45
242.—below elbow...................................................................
124.30
243.Lower limb—above knee...................................................................
172.15
244.—below knee...................................................................
143.45
Other
245.Aspiration of joint...................................................................
23.95
246.Amputation of all or part of 1 digit...................................................................
210.40
247.Extensor tendon, primary repair...................................................................
334.70
248.Nail, simple removal of...................................................................
95.65
SPECIFIED TREATMENT PROVIDER COSTS
249.All treatment...................................................................
19.00
250.X ray services provided by chiropractor (maximum of 2 films per insured per personal injury)...................................................................
15.30 per film.
  • Item 8 was amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by substituting the words whose scope of practice includes a dental speciality recognised by the Dental Council for the words registered as a specialist under the Dental Act 1988.

  • The heading to items 171 to 205 were amended, as from 18 September 2004, by section 175(3) Health Practitioners Competence Assurance Act 2003 (2003 No 48) by omitting the word registered.

  • Items 171 to 177 were substituted, as from 10 January 2002, by section 4 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations 2001 (SR 2001/387).

  • Items 206 and 207, and the preceding heading were substituted, as from 15 October 1999, by regulation 7 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352).

  • Items 208 to 250 were inserted, as from 15 October 1999, by regulation 7 Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 (SR 1999/352).

MARIE SHROFF,

Clerk of the Executive Council.


Explanatory note

This note is not part of the regulations, but is intended to indicate their general effect.

These regulations prescribe the amounts insurers must pay for the costs of treatment (which includes services ancillary to treatment) under the Accident insurance Act 1998.

The regulations come into force, contemporaneously with the Act, on 1 July 1999.


Issued under the authority of the Acts and Regulations publication Act 1989.

Date of notification in Gazette: 15 April 1999.