Treatment
We may be able to fund treatment of service-related conditions.
We put your GP at the centre of your treatment. This gives your GP a broad view of your health and ensures that any treatment plans take into account all the conditions that you might have.
Treatment of service-related conditions
You may be able to get this if:
- you have Qualifying Service, and
- you have a condition related to your Qualifying Service.
If you're looking for mental health treatment, there is a separate page you can visit.
Automatically approved treatment
These costs are approved automatically for your accepted service-related condition (accepted condition) as described on your treatment card:
- GP visits.
- Medicines for approved treatment if on PHARMAC's list of subsidised medicines.
- Diagnostic x-rays and scans up to NZD$1,000 each, if linked to approved treatment. All MRIs need pre-approval.
Prior approval is needed for all other treatment
Prior approval must be sought for all treatment requests associated with an accepted condition on your treatment card. Please contact your case manager if your needs change and you require treatment for an accepted condition. They will work with you to coordinate and arrange prior approval.
We are not responsible for paying or contributing towards treatment or service costs that have been incurred without prior approval. If you'd like us to consider funding, do not proceed to incur costs until you get prior approval. If you proceed without prior approval, we will not reimburse you or cover the cost.
- An appointment with a specialist.
- Scans or x-rays that cost more than NZD $1,000.
- MRIs.
- Routine or conventional treatment (such as Physiotherapy, Psychology, Chiropractor).
- Day or minor surgery (such as a skin cancer removal).
- Dental treatment (including dentures).
- Surgery (such as a joint replacement or heart surgery).
- Complementary or alternative treatment (such as acupuncture)
- Non-subsidised pharmaceuticals
Some treatment costs are limited. Contact your Case Manager to discuss your needs and arrange prior approval.
Common treatment options that we fund with prior approval
- An appointment with a specialist.
- Scans or x-rays that cost more than NZD$1,000.
- MRIs.
- Routine or conventional treatment (such as physiotherapy, psychology, or chiropractic).
- Day or minor surgery (such as a skin cancer removal).
- Dental treatment (including dentures).
- Surgery (such as a joint replacement or heart surgery).
- Complementary or alternative treatment (such as acupuncture).
- Non-subsidised pharmaceuticals.
Some treatment costs are limited. Contact your case manager to discuss your needs and arrange prior approval.
Other costs we may cover with prior approval, if they relate to your accepted condition
- Social rehabilitation, such as occupational therapy or social work to support your independence in your home.
- Equipment for the home to maintain your independence, such as walking frames or wheelchairs.
- Some small housing modifications, such as ramps and rails.
- Some vehicle modifications.
- Hearing aids and accessories such as TV streamers.
Mental health treatment and support
At times, you may require treatment and support for mental health conditions related to your service. We can support you with this. Contact your case manager, and you can work together to find the most appropriate providers.
If you are in crisis, contact the Te Whatu Ora Crisis Service at 0800 745 477.
You can also ring or text 1737 to talk with a trained counsellor.
Non-PHARMAC medicines
Your doctor can apply for medicines not on the list. If PHARMAC declines this, we may consider funding the medicine. We’d need copies of the application to PHARMAC and the decision. We look at:
- research-based evidence that the medicine works
- your situation and needs, including the medication history
- cost.
Contact your case manager to discuss your needs and to arrange prior approval.
Travel for treatment and rehabilitation
We may be able to support your travel costs for assessment, treatment or rehabilitation. We might also be able to cover the travel costs of someone escorting you. Before you start your travel, you must get prior approval from your case manager.
More information about travel for treatment and rehabilitation
Other services to support treatment
We can fund other services, such as accommodation or laboratory tests. You need to:
- have an approved treatment, and
- meet its treatment goals.
Contact your case manager to discuss your needs and to arrange prior approval.
Specialist and private hospital treatment
Requests for specialist or private hospital treatment are assessed on a case-by-case basis. Specialist treatment should be in your local area, where possible.
At times, your specialist may recommend surgery as treatment for your accepted condition. In order for us to consider funding this, we require:
- a specialist report including the full quote for treatment and hospital fees
- evidence of testing Te Whatu Ora’s waitlists in your area
- a completed Private Hospital Surgery form.
Private Hospital Surgery form [PDF, 755 KB]
Contact your case manager to discuss your needs and to arrange prior approval.
Long-term treatment
We can approve a course of treatment for up to 12 months or 12 sessions, whichever is less. We need full details from the provider, including expected outcomes.
Before deciding on further sessions, we need a full report from the provider and may seek a second medical opinion.
Contact your case manager to discuss your needs and to arrange prior approval.
Rongoā Māori
Prior approval must be sought to access Rongoā Māori treatment.
Contact your case manager to discuss your needs and to arrange prior approval.
More information about Rongoā Māori
Social rehabilitation
Prior approval must be sought to access Social Rehabilitation.
Contact your case manager to discuss your needs and to arrange prior approval.
More information about social rehabilitation
Food substitutes
We can fund food substitutes. These must be prescribed by the treatment provider. This treatment provider should first apply to PHARMAC for special authority.
Contact your case manager to discuss your needs and to arrange prior approval.
Counselling for those who support veterans at home
We can fund counselling for people who provide non-professional support to a veteran with a service-related injury or illness. The need for counselling must be a result of that injury or illness.
The support person can be the veteran's:
- spouse
- partner
- child
- dependant
- friend
- flatmate.
Eligible support people can get up to six counselling sessions. They may be able to get additional sessions if the counsellor believes they are needed.
Counselling for family members or support people
Contact your case manager to discuss your needs and to arrange prior approval.
Alternative treatment
We can fund alternative treatment if:
- you have tried all the available standard treatments, and
- an approved treatment provider has prescribed — and is monitoring — a trial period, complete with outcomes measures.
Your approved treatment provider will set these outcomes measures in consultation with you.
We won’t fund alternative treatment if you could have had standard treatment but refused.
Contact your case manager to discuss your needs and to arrange prior approval.
Overseas clients
If you're living overseas, the treatment must:
- be generally accepted in New Zealand
- be carried out by a certified practitioner registered with the relevant professional body
- be pre-approved.
We won’t pay costs covered by the public health or accident compensation system of your country of residence.
Contact your case manager to discuss your needs and to arrange prior approval.
To apply for treatment of an accepted condition, contact your case manager.
After you apply we'll:
- contact you to confirm we've received your application
- start the decision-making process
- keep you informed on the status of your application.
If we need more information, we'll get in touch with you.
We'll work with you to make a plan covering:
- conditions we’ll fund treatment for
- medicines and treatments we’ll fund, including how often and how long or how many sessions
- treatment goals, your progress toward them, and any reassessment needed.
If a treatment isn’t meeting the goals, we may look at:
- changing provider
- ending funding for the treatment
- funding another treatment as well as the current one
- funding another treatment instead of the current one.
Contact us for more information
We strive to be transparent. If you want to know how this entitlement is administered you can read the internal policies.
Treatment policy [PDF, 423 KB]
