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New Zealand has a comprehensive public health system. Public healthcare generally covers treatment for acute conditions and injuries from accidents, subsidised general practitioner (GP) visits and prescriptions, and, for children under 14 years old, free GP consultations.
However, many New Zealanders still face healthcare challenges, especially in getting fast medical attention for chronic conditions. Due to increasing demand, some Kiwis have had to wait several months to a few years to have elective surgeries in public hospitals.
These long waiting times can have negative consequences on patients’ health and quality of life before and after their treatment. As a result, many Kiwi patients may try to go to private hospitals to have their procedures done sooner, especially if their condition is causing them debilitating pain.
New Zealand also lags behind in terms of public funding for modern medicines. A global study published in May 2020 found that public funding was available for only 24 out of the 403 modern medicines introduced in the Organisation for Economic Co-operation and Development (OECD) between 2011 and 2018.
Because of this, some Kiwi patients take out loans or mortgages, rely on fundraisers, deplete their emergency savings and retirement funds, or find other ways to be able to afford non-PHARMAC funded drugs and treatments.
Private health insurance broadens your healthcare access and options, empowering you to choose where to get treated and what medications to use.
As of June 2021, more than 34% of New Zealand adults reported having private health insurance coverage and access to its benefits, including:
Shorter wait times. Having health insurance gives you the option to go to private hospitals for tests, consultations and treatments without worrying about the costs. Skipping long waiting times also means you can be free from the pain or discomfort caused by your health condition as soon as possible.
You no longer have to put your life on hold. You can recover faster and go back to work or resume your hobbies sooner.
Kiwi residents can get private health insurance for themselves, their partners, families and employees.
But it’s important to note that these private health insurance plans can vary greatly in terms of benefits. Plans may cover just day-to-day benefits or major expenses such as hospitalisation and surgery. Other plans offer comprehensive insurance, combining the benefits of everyday plans and hospital cover.
Below are some of the healthcare costs covered by insurance. Keep in mind that this is not an exhaustive list, and coverage will vary depending on your health insurance plan. Some insurers may include these benefits in their base plans, while others offer these as add-ons.
Major Policies/Hospital Cover for major healthcare costs such as:
Cancer diagnosis, treatment, follow-up consultations, travel and accommodation
Minor Medical Expenses/Day-to-Day Treatments including:
GP consultations
Dental check-ups and treatments like cleaning, fillings, extractions, root canal therapy, crowns, dentures, and endodontic and orthodontic treatments
Pharmaceutical prescriptions
Mental health services (psychologist or psychiatrist consultations)
Allied and therapeutic care such as physiotherapy, chiropractic, acupuncture and traditional Chinese medicine
The type of coverage appropriate for you and your loved ones will depend on your circumstances and financial capacity. But here are a few essential coverages you may need to consider.
Cancer Cover
Cancer cases continue to rise in New Zealand, and cancer-related diseases have become the leading cause of death in New Zealand. According to the Ministry of Health, the number of new cancer registrants in 2018 reached over 26,000, while the number of cancer-related deaths in 2017 was more than 9,000.
While cancer treatments are available, their prices are often steep. According to nib, chemotherapy and radiotherapy in private facilities can cost $15,000–$170,000 and $20,000–$55,000, respectively.
New Medsafe-approved treatments are available for a number of diseases, but many of these are not yet publicly funded. Health insurance plans with non-PHARMAC cover can help patients pay for these treatments.
This benefit covers in-hospital and surgery-related services such as hospital accommodation and required supplies, prescriptions, diagnostic exams and post-treatment care.
This benefit becomes crucial when patients need elective surgery and would like to avoid long wait times at public health facilities.
Not all illnesses can be treated with surgery. When choosing a plan, ask about non-surgical benefits such as allergy treatments and IV infusions.
Check the types of tests and amounts your preferred plan will cover for diagnostic procedures such as x-rays, MRI exams, CT scans, and PET scans.
When choosing a plan, you must understand what’s covered and what’s excluded in your health insurance policy. Contact us if you need help determining the best insurance plan for your needs
Below are some procedures and conditions that are often excluded in health insurance policies:
Be sure to ask your Policywise adviser about these exclusions and read your insurance plan’s fine print.
Pre-existing conditions’ refers to health conditions, symptoms and injuries you already have before you buy your health insurance plan.
Some health insurers will cover pre-existing conditions after a specific number of years. But many of them will never cover the following:
Since younger adults are generally healthier, it’s best to get health insurance while you’re young and are less likely to have pre-existing conditions that can limit your cover.
Contact Policywise if you need help with health insurance exclusions and pre-existing conditions. Our advisers are trained to negotiate with your chosen provider for the lowest number of exclusions. If you have pre-existing conditions, Policywise can help you find the best health insurance plan for your medical circumstances.
Insurance plans have differing maximum claim amounts per policy year. Higher limits may be beneficial for conditions like cancer, but are not as necessary for other health conditions and procedures.
To give you an idea of how much health insurance you actually need, check out the data below on private healthcare costs with no insurance coverage.
Several factors can affect the cost of your premiums. These include:
Contact us today to get your FREE, no-obligation health insurance quote.
Below are some ways to lower your premiums or get a deduction:
Experienced Policywise advisers can help you get the most appropriate, cost-effective health plan for your needs. Contact us to request a quote.
Below are the top-rated health insurance companies in New Zealand and an overview of their plans.
Nib New Zealand is part of nib Group, which specialises in health and medical insurance for Australian and New Zealand residents.
Policywise offers the following nib individual and family plans:
Aside from individual plans, nib also offers health insurance plans for businesses. The comprehensive base plan includes hospital surgical and non-surgical costs, diagnostic tests, and cancer treatment. Employers and employees can opt for add-ons like non-PHARMAC cover, serious condition lump sum, and dental and optical cover.
Accuro is a not-for-profit health insurance cooperative offering health insurance plans for:
Accuro’s plans primarily include hospital and surgery cover. Everyday costs like dental plans and GP consultations can be included as add-ons.
Plan for Visitors and Work Visa Holders Staying for Less Than Two Years
Accuro offers the following:
Southern Cross is a not-for-profit insurer offering a range of health plans for individuals, families and businesses.
Southern Cross has a variety of individual plans, such as:
Depending on your plan, you may have the option to add Cancer Assist (a one-off payment after a qualifying cancer diagnosis), Critical Illness, and Cancer Cover Plus (for additional chemotherapy for cancer and non-PHARMAC funded chemotherapy drugs).
Partners Life’s health insurance plans for families and businesses include:
AIA’s individual health insurance products include:
Be sure to consider the implications before switching to a different insurer or plan. For example, if you have pre-existing conditions, these may not be covered (or may have conditions) in your new plan. It’s important to clarify these exclusions with your insurer or health insurance adviser.
Contact Policywise if you need more information and guidance on changing insurers or plans. They can help you weigh the benefits and trade-offs of cancelling your current policy and taking out a new one.
When you’re unfamiliar with health insurance, understanding the terms, benefits, inclusions and exclusions on your own can be overwhelming.
What makes the choice even more difficult is that health insurance plans come in different packages. This makes comparisons more confusing.
A Policywise adviser can simplify the comparisons for you.
Advisers provide ongoing support. They can help you process and negotiate your claims. Advisers can also coordinate with insurers about changes that affect your policy, such as having exclusions removed or adding your new baby to your plan, and they can negotiate lower premiums if you quit smoking.
Do you want an easy, effortless way to file claims? Let Policywise’s insurance experts do the heavy lifting and file and negotiate claims on your behalf.
If you prefer to file claims on your own, we’ve outlined the general steps below. Be sure to check these with your insurer, in case they have other requirements for making claims. Some insurers may also advise you to download their app to submit your claim online.
Visit a general practitioner who is registered with the Medical Council of New Zealand. If they advise you to see a specialist, ask if they have a recommended clinic or specialist. You can also ask for an open referral, so your health insurer can select a specialist or private hospital for you.
Some insurers offer full coverage only if you go to their affiliated health providers. Be sure to check with your insurer if this is one of their requirements for making a claim.
Once you know what consultations, tests and procedures you’ll need, ask your insurer about the benefit limits for each and apply for pre-approval.
Securing pre-approval can help you better plan and prepare for your treatment. It gives you the assurance that your claims will be processed and/or you will be reimbursed for healthcare costs. It also allows you to prepare financially in case part of the costs are not covered by your insurance plan.
Your health insurer covers the medical cost. Depending on the health insurance plan you have, this may include consultations, procedures, medications and post-recovery expenses. Your insurer will either pay the healthcare provider directly or reimburse your medical expenses.
If you opted for an excess or a cost-sharing plan, you will be paying for part of the medical bill.
Private health insurance is a smart investment to protect you and your loved ones’ health and finances in the event of illness requiring costly treatment. The premiums you pay entitle you to benefits that could otherwise cost hundreds of thousands of dollars each year. Health insurance gives you the assurance that costs and long waiting times will not prevent you or your loved ones from getting life-saving or life-extending treatment.