Health and medical insurance
Treatment when it is needed, rather than when a waiting list allows.
What health cover is for
New Zealand's public health system handles acute care well. If you have a heart attack on a Tuesday, you will be treated on a Tuesday, and the standard of that care is high.
Planned care is a different matter. Investigations, specialist appointments and elective surgery are rationed by clinical threshold and by capacity, and both move. Health insurance buys certainty about timing and about who treats you, for the things that are not emergencies but are not optional either.
It is also, for many households, the policy most likely to be claimed on. Life cover is held for decades and used once. Health cover tends to be used.
What a policy is made of
Surgical and major medical is the core: private hospital admission, surgeon and anaesthetist fees, the diagnostics that accompany treatment, and specialist care. Almost all of the value of health insurance sits here.
Specialist and diagnostic cover extends to consultations and imaging that do not lead to surgery, which is where a great many claims begin and where a policy without it leaves a gap.
Non-Pharmac medicines cover contributes to approved treatments that the public system does not fund. In oncology in particular this benefit has become the reason many people hold health insurance at all.
Everyday benefits cover general practice, dental, optical and physiotherapy. They are the most visible part of a policy and the least efficient. For most households that premium is better spent on a higher excess and a stronger core.
What we look at when arranging cover
The excess
The single most effective lever on premium. Raising it converts a policy from paying small bills to answering large ones, which is what insurance is for.
Pre-existing conditions
What is excluded, whether it is excluded permanently, and what evidence would lift it later.
Non-Pharmac limits
The annual amount, whether it applies per condition or per year, and what approval process sits behind it.
Specialist and diagnostics
Whether consultations and imaging are covered before any surgery is agreed, and to what limit.
How premiums move with age
Health premiums rise with age on every insurer. How steeply, and how transparently, varies.
Continuity
What happens to your cover if you change insurer, leave an employer scheme, or move overseas and return.
Timing, and why it decides so much
Health insurance is underwritten on the day you apply. Everything you have had symptoms of, sought advice about or been treated for before then is generally excluded, whether or not it was ever given a name.
That makes this the one cover where the argument for arranging it early is not really a financial argument. A policy taken out for a child at birth insures a person with no history at all. The same policy taken out at forty-five insures around whatever has happened in between.
It also makes switching insurers for a lower premium a decision to take slowly. Anything that has arisen since your current policy began will usually be treated as pre-existing by the new insurer, unless continuity is negotiated as part of the transfer.
What shapes the premium
Age above all, then the excess, the level of cover chosen, smoking status, and whether the policy is individual or part of a family or employer scheme. Unlike life cover, health premiums are age-rated throughout and will rise every year regardless of claims.
Managing that increase over a long holding period, without hollowing out the cover in the process, is most of what good advice on this product consists of.
At claim time
Most health claims are made before the treatment rather than after it. Getting prior approval right is the difference between the insurer settling directly with the hospital and your household paying the bill and hoping to be reimbursed.
We handle that approval: the specialist's recommendation, the estimates, and the question of whether anything about the condition touches an exclusion written into the policy years earlier. Where an insurer queries a claim, we answer it.
This is the cover you are most likely to use, probably more than once, and often at short notice. Of all the policies on this site, it is the one where having someone to call is worth the most.
Common questions
What does health insurance actually cover?
The core of any policy is surgical and major medical: private hospital admission, the surgeon and anaesthetist, diagnostic imaging related to the treatment, and the associated specialist care. Everyday benefits covering general practice visits, dental, optical and physiotherapy are optional additions, and they are the part most likely to cost more in premium than they return in claims. The core is where the value sits.
Are pre-existing conditions covered?
Generally not, at least at the outset. Anything you have had symptoms of, sought advice about or been treated for before the policy starts is usually excluded, whether or not it had been diagnosed. Some exclusions are reviewed after a period without symptoms or treatment. This is the whole reason to arrange cover while you and your children are well.
What is a non-Pharmac medicines benefit?
Pharmac funds a defined schedule of medicines for use in the public system. Some treatments approved for use in New Zealand are not on that schedule, and meeting the cost privately can be substantial, particularly in oncology. Several insurers now offer a benefit that contributes to approved unfunded medicines up to an annual limit. The limits, and the conditions attached to them, differ considerably between insurers.
Should I switch insurers to get a lower premium?
Be careful. Moving to a new insurer usually means anything that has arisen since your original policy started becomes a pre-existing condition with the new one. A saving of a few hundred dollars a year can quietly cost you cover for the condition most likely to need it. Where a transfer is worth doing, it is done on terms that preserve continuity, and that has to be negotiated in advance, not assumed.
Is the cover I get through my employer enough?
Employer schemes are often good value and frequently cover the family. Two things are worth knowing: the cover normally ends when the job does, and taking out a personal policy years later means underwriting at your age and health then, not now. Where an employer scheme allows a personal continuation on transfer terms, that option is worth understanding before you need it.
Cover that often sits alongside this
- Trauma and critical illness cover pays a lump sum on diagnosis, which meets the costs a health policy does not: income, travel, and everything outside the hospital.
- Income protection the treatment being paid for does not pay the mortgage while you recover from it.
- Life cover the foundation most plans are built on.
- How we advise what we look at, in what order, and what happens at a claim.
Talk to us about health cover
An initial consultation runs about an hour, in our Garden Place rooms in Hamilton. You sign one thing: confirmation that you have received our disclosure statement and understood it. Nothing else.
This page is general information about how this type of cover works. It is not financial advice for your circumstances. Advice is given after we understand your position. See our disclosure statement.