Treatment

We may be able to fund treatment of service-related conditions.

If you're looking for Mental Health Treatment visit its page.

Mental Health Treatment page

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Who can get this

You may be able to get this if:

  • you have Qualifying Service, and
  • you have a condition related to your Qualifying Service.

Qualifying Service explained

What you can get

Automatically approved treatment

These costs are approved automatically for your accepted condition:

  • doctor 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.

Any other costs must be pre-approved except in an emergency situation when you:

  • can’t reasonably seek and get pre-approval, and
  • can’t get the treatment through the public health system.

You can seek pre-approval through your case manager.

Medicines

We’ll usually only fund medicines on PHARMAC's subsidised list.

Your doctor can apply for medicines not on the list. If PHARMAC declines this, we may consider funding the medicine ourselves. We’d need copies of the application to PHARMAC and the decision. We look at:

  • research-based evidence the medicine works
  • your situation and needs
  • cost.

Long-term treatment

We can approve a course of treatment for up to 12 months or 12 sessions, whichever’s 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.

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.

Specialist and private hospital treatment

Requests for specialist or private hospital treatment are assessed case by case. Specialist treatment should be in your local area, where possible.

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 goals.

Alternative treatment

We can fund alternative treatment if:

  • you have tried all the available standard treatment, 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.

Overseas clients

If you're living overseas the treatment must meet these conditions:

  • Generally accepted in NZ.
  • Carried out by a certified practitioner, registered with the relevant professional body.
  • Pre-approved.

We won’t pay costs covered by the public-health or accident-compensation system of your country of residence.

How to apply
  1. Complete the Treatment and Rehabilitation application form.
  2. Send the application form and any supporting information to us.

Download the Treatment and Rehabilitation application form [PDF, 380 KB]

What happens next

After you apply we'll:

  1. contact you to confirm we've received your application
  2. start the decision-making process
  3. keep you informed on the status of your application.

If we need more information, we'll get in touch with you.

How we make decisions

When you get it

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.
Find out more

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, 541 KB]

Dental Treatment policy [PDF, 424 KB]

Private Treatment policy [PDF, 402 KB]

Skin Cancer Treatment policy [PDF, 420 KB]