nib vs Southern Cross: Plans, benefits and costs

nib vs Southern Cross: which is a better fit for you?

Southern Cross UltraCare suits you if you want everyday care, specialist access, and mental health consultations inside base cover, with no excess and no co-payment. nib's Ultimate Health Max and Easy Health suit you if you want unfunded-medicine cover that reaches beyond cancer, or, on Easy Health, a route to cover for pre-existing conditions after three years.

The two insurers diverge on four mechanics more than any others:

• What base cover includes. UltraCare pays GP visits, prescriptions, physiotherapy, and optometry as base benefits. On nib's Ultimate Health and Ultimate Health Max, this sits in optional modules; Easy Health has no module that restores it at all.
• Mental health. Southern Cross covers consultations in base cover on every plan here, though Wellbeing's is psychiatrist-only while UltraCare also covers registered psychologists. All three nib wordings exclude mental health outright, though Ultimate Health Max carries a narrow, claim-triggered counselling benefit after a paid cancer or cardiac claim.
• What you pay per claim. UltraCare carries no excess and no co-payment. nib offers an optional excess, and Ultimate Health and Easy Health apply a 20% member share to several diagnostic benefits.
• Choice of provider. Wellbeing One and Wellbeing Two will not cover some services at all unless an Affiliated Provider delivers them. UltraCare has no such list, and nib never restricts eligibility by network, because the network affects reimbursement rather than eligibility.

Two things the evidence does not support, and which you should not read into a comparison chart. Neither insurer publishes a concession for switchers, so neither is the safer plan to move to. And nib's Ultimate Health Max wording sets out no network price cap, which is not the same as a promise that no gap can ever reach you.

nib and Southern Cross side by side

The six plans in scope here are nib's three adviser plans and Southern Cross's UltraCare and Wellbeing tiers. Premiums are quote-based on both sides, so the table below compares cover mechanics rather than price. Read the mental health row with the note beneath it.

nib separately offers up to $2,500 a year of psychologist and psychiatrist consultations on Ultimate Health and Ultimate Health Max. That offer sits outside the policy wording, so treat it as a programme nib currently runs rather than a contractual benefit.

Southern Cross's Wellbeing excess applies only to surgery, chemotherapy, and radiotherapy, not to every claim. Read Wellbeing One's specialist and diagnostic limits with its six-month condition, explained under its own heading below.

nib vs Southern Cross cost comparison

Neither insurer publishes a price list. Both underwrite each application individually, and quote on age, plan, excess, smoking status, and the options you choose. Your nib premium appears on your own certificate, while Southern Cross confirms your quote when you apply. What you can compare before you apply is what a claim costs you afterwards.

Sample premiums compared

The premiums below are sample quotes, prepared for a stated age, plan, excess, and smoking status. They illustrate how each insurer prices the same cover for the same person. Your own quote will differ, because both insurers rate on your age and medical history. Southern Cross also moves members to common rating at 75.

NOTE: Quotes generated in October 2026. Indicative only. Actual premiums depend on individual underwriting. No policy fee.

Excesses and co-payments

An excess is the amount you pay per claim before your insurer contributes, and it is usually scalable, so a higher excess buys a lower premium. A co-payment is your percentage share of an eligible cost. UltraCare has neither. The nib plans and the Wellbeing plans each use one or both.

On all three nib plans an excess is optional, chosen by you, and applies once per person per policy year. Where a co-payment applies as well, it comes off first. nib's own worked example: on a $2,000 procedure with a 20% co-payment and a $500 excess, you pay $900 and nib pays $1,100.

The co-payments differ by plan:

• Ultimate Health Max pays 100% of eligible costs in base cover. The Dental, Optical and Therapeutic Option and the Proactive Health Option pay 80%.
• Ultimate Health applies an 80/20 split across most base diagnostic benefits, and pays 100% where the item appears on nib's Diagnostics Schedule.
• Easy Health applies the same 20% member share to diagnostic investigations, hospital diagnostic tests, and hospital specialist consultations.

Southern Cross runs no co-payment structure on UltraCare, or on Wellbeing base cover; only the optional Vision and Dental Module carries a 25% co-payment. UltraCare carries no excess at all. Wellbeing One and Wellbeing Two offer an optional $500, $1,000, $2,000 or $4,000 excess.

The excess applies per person, once per claims year, and only to surgical procedures, chemotherapy and radiotherapy. It does not apply to the Vision and Dental Module or any other optional module. The Vision and Dental Module leaves you 25% of glasses and dental costs.

For more on how the mechanic works, see what is an excess on insurance.

Gap payments

A gap payment is the shortfall between what your provider charges and what your insurer will pay. On Ultimate Health and Easy Health that gap appears when you go outside nib's First Choice Network. nib pays up to its own Efficient Market Price, and you cover the rest.

Southern Cross prices the gap differently. It pays actual or reasonable charges up to each benefit's limit. Your exposure is any amount above its assessment of reasonable charges, or above a stated limit. Prior approval, recommended at least five working days ahead, tells you in advance whether an estimate exceeds either.

Ultimate Health Max sits outside both models. Its wording contains no network and no Efficient Market Price cap. nib instead assesses claims against usual, customary and reasonable charges, and negotiates directly with a provider whose costs are much higher.

Whether a residual gap can still reach the member is not stated in the documents available for this comparison, so do not assume Ultimate Health Max is gap-free. For typical dollar figures, see cost of private surgery.

How to choose between nib and Southern Cross

Choosing between nib and Southern Cross means working through the benefits you're most likely to claim, in the order they will cost you money. Start with the surgical ceiling and what you pay per claim, then everyday care, mental health, and unfunded medicines. Your medical history decides what either insurer will cover, regardless of these other mechanics. Then compare health insurance plans on those mechanics.

• You have a pre-existing condition. Easy Health is the only plan here with a standard three-year waiting period after which eligible pre-existing conditions become coverable. UltraCare may lift its exclusion after three years' continuous cover.
• You want everyday care. UltraCare pays GP visits, prescriptions, physiotherapy, and optometry from base cover. On Ultimate Health and Ultimate Health Max you buy the GP Option and the Dental, Optical and Therapeutic Option; Easy Health has no everyday-care route on any option.
• You want counselling or psychiatry covered contractually. Southern Cross is the only side of this comparison whose policy wording covers general, standalone counselling or psychiatry.
• You are worried about unfunded cancer medicines. Ultimate Health Max covers non-Pharmac medicines in hospital and at home from base cover, and adds an option on top. Ultimate Health covers them for cancer only, to $20,000 a year.
• You want to keep your specialist. UltraCare and the nib plans never make cover conditional on using a particular provider. Wellbeing One and Wellbeing Two do, for some services.

Two axes cannot decide it for you. Neither insurer offers a switching concession, and the gap exposure on Ultimate Health Max is not established.

Talk to a Policywise adviser about which mechanics matter for your own health history, rather than choosing on the surgical limit alone.

How nib and Southern Cross compare as companies

The two are built on opposite models. Southern Cross Medical Care Society is a not-for-profit Friendly Society that returns most of its premium income to members as claimed.

nib's New Zealand business is part of the nib Group, whose ultimate parent, nib holdings limited, is listed on the Australian Securities Exchange under the code NHF. Both hold active FMA Financial Institutions licences granted on 31 March 2025.

Key facts about nib

nib nz limited is one of the country's largest health insurers, with around 17.8% of the market. It entered New Zealand in 2012 by acquiring TOWER Medical Insurance, added OnePath's medical business in 2015, and Kiwi Insurance in 2022.

From mid-2024 nib's two New Zealand entities were amalgamated into one company. All health, life, and living policies are now insured by nib nz limited. Claims rose sharply in the first half of 2025: nib's health insurance claims rose 27.3% to $159.7 million, from $125.5 million, while policyholder numbers stayed stable.

Key facts about Southern Cross

Southern Cross Health Society is a Friendly Society, registered under the Friendly Societies and Credit Unions Act 1982. It describes itself as a 'for purpose' entity operating for members' benefit. It had 951,808 members as of 30 June 2025, a fall of 3,493 on the previous year. It puts its share of the market at around 60%.

In the 2025 financial year it paid a record $1.706 billion in claims across 3.8 million claim lines, against $1.811 billion of premium income. That returned 94 cents of every premium dollar to members as claims.

On that measure, Southern Cross returns strong value to its members. Note that the Society is legally separate from Southern Cross Healthcare, the hospital network, which sits under a charitable trust.

For the full picture, see Southern Cross health insurance.

Financial strength and credit ratings

Both insurers hold a strong financial strength rating from the same agency, S&P Global Ratings Australia Pty Ltd. Southern Cross Medical Care Society is rated A+ (Strong) and nib nz limited A (Strong). Both insurers disclose their grade as currently in effect.

Neither publishes the date its rating was given, or the outlook attached to it, and neither is required to. Section 64 of the Insurance (Prudential Supervision) Act 2010 requires a licensed insurer to disclose the current rating, the agency, and the rating scale only. Treat both grades as current-as-disclosed rather than as a dated ranking.

The solvency figures do carry a date, and both sit above the regulatory minimum:

• nib NZ limited: adjusted solvency 118% as at 30 June 2026, with capital of $662.5 million against $563.7 million required.
• Southern Cross: adjusted solvency 1.27 for the group and 1.25 for the Society as at 30 June 2026.

What do nib's health plans cover?

nib sells three health plans through advisers, and they sit in a clear order: Easy Health entry level, Ultimate Health in the middle, and Ultimate Health Max the top tier. All three are surgical and hospital plans first, so if you want everyday care, unrestricted specialist access, or dental, you'll need an optional module rather than base cover.

Ultimate Health Max

Ultimate Health Max is nib's top-tier plan. If you choose it, you get $600,000 a year for surgery and $300,000 for non-surgical treatment, with no co-payment in base cover.

It is the only nib plan whose base cover includes Medsafe-approved but Pharmac-unfunded medicines beyond cancer, both in hospital and at home, without needing an add-on. On Easy Health you can reach the same ground only by adding the Non-PHARMAC Plus Option.

Base cover also includes a cancer treatment benefit drawn from the non-surgical limit, follow-up investigations for cancer to $3,000 a year for five years, and an ACC top-up.

Six options are available:

• Specialist
• GP
• Dental, Optical and Therapeutic
• Non-PHARMAC Plus
• Proactive Health
• Serious Condition Financial Support

For the fuller picture, see Policywise's nib health insurance review.

Ultimate Health

Ultimate Health carries the same $600,000 surgical and $300,000 non-surgical limits as Ultimate Health Max, but a narrower base. If you choose it, its non-Pharmac benefit covers cancer treatment only, in a private hospital, to $20,000 a year. The Non-PHARMAC Plus Option is not available on this plan.

Most base diagnostic benefits pay 80%, rising to 100% where the item is on nib's Diagnostics Schedule. Five options are available, and the First Choice Network applies to this plan and to all its options. The nib health insurance review sets out each option in more detail.

Easy Health

Easy Health is nib's entry plan. If you choose it, you get $300,000 a year for surgery and $200,000 for non-surgical treatment, and its distinguishing mechanic is a pre-existing-condition waiting period.

After three years' continuous cover, eligible pre-existing conditions become coverable, the only plan here where the lift is automatic rather than discretionary. UltraCare's three-year concession is discretionary and excludes Cancer Cover Plus and a list of chronic conditions.

Six categories stay permanently excluded regardless of how long you hold the plan, including cardiovascular conditions, cancer, hip or knee conditions, and back conditions. Easy Health also has no route to everyday care: routine GP visits, prescriptions, dental, and optical are excluded, and no option restores them.

Compare it directly in the Southern Cross UltraCare vs nib Easy Health article.

Other cover nib offers

nib also sells life and disability cover through advisers, under its Ultimate Life & Living range. If you have nothing in place for the income side of a serious diagnosis, a health plan alone won't cover it. It pays treatment providers rather than replacing your earnings.

The range covers six needs:

• nib life insurance, and trauma insurance, which pays a lump sum on diagnosis of a covered serious condition
• Income protection insurance, on an agreed value or an indemnity basis
• Mortgage protection insurance
• Total and permanent disability cover
• Waiver of premium

If a serious illness would leave a gap in your household income, trauma insurance is the cover that sits alongside a health plan rather than duplicating it. A Policywise adviser can quote it alongside your health cover.

What do Southern Cross's health plans cover?

If you're comparing Southern Cross, its current individual and family range spans six plans: HealthEssentials, Wellbeing One, Wellbeing Two, UltraCare and UltraCare 400, KiwiCare, and RegularCare. Wellbeing Starter is closed to new members. This article focuses on UltraCare, Wellbeing One, and Wellbeing Two, the plans Policywise most often recommends for you.

The plans outside that focus work differently:

• KiwiCare and RegularCare reimburse 80% of eligible charges, leaving a 20% co-payment, with an optional $500 excess. RegularCare adds day-to-day treatment; neither offers the optional modules.
• HealthEssentials reimburses 75% across primary care, dental, eye care, and ear care, with no hospital, surgical or specialist cover.
• Cancer Assist and Critical Illness are lump-sum add-ons that attach to an eligible health policy, not health plans. See trauma insurance vs disability or critical illness cover for how lump-sum cover compares with income protection.
• Wellbeing Starter is a legacy plan. Existing policyholders can still add dependants, but it is no longer for sale.

UltraCare

UltraCare is the only one of the six plans compared here that pays everyday care from base cover. If you choose it, surgery is unlimited at reasonable charges, specialist consultations run to $10,000 a year, diagnostic imaging to $100,000 and cardiac tests to $5,000.

Your day-to-day benefits include GP visits at $100 each, prescriptions to $600 a year, physiotherapy at $60 a visit to $300 a year, and optometry to $350 a year. There is no waiting period on them, and the pre-existing condition exclusion does not apply.

UltraCare 400 adds dental to $750 a year and glasses to $500. See how it compares with nib's entry plan in Southern Cross UltraCare vs nib Easy Health.

Wellbeing One and Wellbeing Two

Wellbeing One and Wellbeing Two share one policy document and one benefit structure, and differ on the six-month condition and two added benefits.

On Wellbeing One, specialist consultations, diagnostic imaging, cardiac tests, diagnostic tests, and dietitian consultations are covered only within six months before or after related eligible surgery, chemotherapy, or radiotherapy (oncologist and radiation oncologist consultations are exempt from this condition).

Wellbeing Two removes that six-month condition, adds laboratory tests to $70 a year, and adds an obstetrics allowance of $750 a year after one year on the plan.

If you choose either plan, everyday care sits in four optional modules, and Keeping Well cannot be held alongside Day-to-day or Vision and Dental. The Southern Cross Wellbeing One vs Two comparison covers the choice between them.

Cancer cover and non-Pharmac medicines

Both insurers cover cancer treatment, and they differ most on medicines Pharmac does not fund. Pharmac decides which medicines are publicly funded; Medsafe decides which are approved for sale. A medicine that is 'non-Pharmac but Medsafe-indicated' is approved for use in New Zealand but not subsidised.

nib's own published figures put Tafinlar for melanoma at over $80,000 a year, and Avastin for bowel cancer at $25,000 to $30,000 a year, plus administration fees.

Cover splits as follows:

• Ultimate Health Max covers non-Pharmac medicines in hospital and at home as base benefits, paid from the surgical or non-surgical pool. The Non-PHARMAC Plus Option adds a separate limit on top.
• Ultimate Health covers them for cancer only, in a private hospital, to $20,000 a year, with no option available.
• Easy Health covers non-Pharmac cancer medicines to $20,000 a year, and the Non-PHARMAC Plus Option extends that to other conditions at $20,000 to $300,000.
• UltraCare, Wellbeing One, and Wellbeing Two cap chemotherapy at $60,000 a claims year, including a $10,000 sub-limit for non-Pharmac drugs, and radiotherapy is unlimited. An excess applies on Wellbeing One and Wellbeing Two but not on UltraCare, and Wellbeing's chemotherapy and radiotherapy must be delivered by an Affiliated Provider.

Southern Cross's Cancer Cover Plus upgrades remove that $10,000 sub-limit, lifting the chemotherapy maximum to $100,000 or $300,000 a year. Three restrictions apply. The upgrade is fully underwritten regardless of any pre-existing condition concession, it can only be purchased while every member on the policy is under 60, and a family-history-of-cancer exclusion can apply per person.

The funded picture is also moving. Pharmac received $604 million over four years in June 2024, and a further $54 million in Budget 2026. It funded six more cancer medicines from 1 April 2025, and five more medicines, including new cancer treatments, from 1 December 2025.

Annual cancer diagnoses are projected to rise from over 30,000 in 2025 to more than 45,000 by 2044. For cost context, see cancer treatment costs and non-Pharmac drugs.

Mental health cover

Southern Cross covers mental health consultations in base cover on all three plans here. All three nib policy wordings exclude psychiatric, psychological, behavioural, and developmental conditions outright, though Ultimate Health Max carries a narrow, claim-triggered counselling benefit of up to $400 per condition after a paid cancer or cardiac claim, not general mental health cover.

What Southern Cross pays depends on the plan, and on who you see:

• UltraCare: mental health consultations to $1,500 a claims year, covering a psychiatrist or a registered psychologist, with no excess, no co-payment, and no waiting period.
• Wellbeing One and Wellbeing Two: psychiatrist consultations only, to $750 a claims year. A registered psychologist is not covered under that benefit, though the Keeping Well Module adds $100 a year of clinical psychology.
• Both plan families: psychiatric hospitalisation to $3,500 a claims year, with sub-limits of $700 a night and $200 a year for ancillary charges.

nib runs a separate offer that its wordings do not contain. Members on Ultimate Health or Ultimate Health Max can claim up to $2,500 a year for registered psychologist and psychiatrist consultations. nib pays 100% of eligible claims, with no waiting period, no excess, and no pre-existing condition exclusions, though conditions apply. Easy Health is not eligible.

Because that benefit sits outside the policy schedule, it is best read as a programme nib currently offers rather than cover you hold contractually. If mental health cover is the reason you are comparing insurers, ask Policywise to confirm the current terms in writing before you apply.

For scale, 183,356 people used specialist mental health and addiction services in Aotearoa New Zealand in 2024/25, the highest number since 2020/21. Private fees are not published by any New Zealand body.

As a government-set reference point, ACC's funded rate for a psychiatry consultation was $122.94 including GST for a first visit. A follow-up was $48.20, effective 1 June 2024. That is an ACC rate, not a private market fee.

Maternity and fertility treatment

Both insurers cover little maternity and fertility treatment here, likely because New Zealand's public system already covers most maternity care.

A Lead Maternity Carer takes responsibility for your care through pregnancy, labour, birth, and the baby's first six weeks. Midwifery-led care is free to eligible residents, while a private obstetrician charges a fee.

What each plan pays:

• Ultimate Health Max: a High-Risk Pregnancy Benefit of $4,000 per pregnancy for obstetrician care assessing or monitoring recognised risk factors, such as gestational diabetes or preeclampsia.
• Ultimate Health and Easy Health: the same benefit at $2,000 per pregnancy.
• UltraCare: an obstetrics allowance of $1,000 a claims year, after one year's continuous cover.
• Wellbeing Two: an obstetrics allowance of $750 a claims year, after one year on the plan. Wellbeing One has no obstetrics benefit at all.

Normal pregnancy and childbirth are excluded on every plan here, and so are IVF, assisted reproduction and infertility treatment. No option or module on either side adds them.

A specialist fertility assessment may be publicly funded if you meet the criteria. Referral is generally suggested after 12 months trying to conceive. That shortens to nine months if she is over 35, and six months if she is over 40.

Health New Zealand does not publish the scoring it uses, and going private means paying for the assessment and any treatment yourself. No private IVF or obstetric figure is quoted here, because no trusted New Zealand source publishes one.

Day-to-day, diagnostic and everyday care

UltraCare is the only one of the six plans this article compares in depth that pays everyday care from base cover. Ultimate Health and Ultimate Health Max need a paid option for GP visits, prescriptions, and dental; Easy Health has no option that provides any of them.

UltraCare's day-to-day benefits are paid at actual charges, with no waiting period and no pre-existing condition exclusion:

• GP visits at $100 each, and nurse visits at $30
• Prescriptions to $600 a year, for Pharmac-approved medicines
• Physiotherapy, chiropractic, and osteopathy at $60 a visit, to $300 a year each
• Optometry at $70 a visit, to $350 a year, and podiatry to $400 a year
• An annual health check to $100, and one flu vaccination a year

On the Wellbeing plans the same ground sits in optional modules. The Day-to-day Module pays GP visits at $65, prescriptions to $600 a year, and physiotherapy to $300. The Vision and Dental Module pays 75% of glasses and dental to $500 and $750 a year respectively. A module cannot be removed until your next policy anniversary.

nib splits everyday care across two options. The GP Option pays 100% after a 90-day wait, covering GP consultations at $55 each up to 12 a year, prescriptions, and physiotherapy. The Dental, Optical and Therapeutic Option pays 80% after six months. Dental runs to $500 a year, and eye care to $275 for consultations plus $330 for eyewear.

Diagnostics divide the same way. UltraCare covers specialist consultations to $10,000 a year and imaging to $100,000 without needing a hospital admission first.

On Ultimate Health and Ultimate Health Max, base diagnostic investigations such as colonoscopy, CT, and MRI need only a referral, not a hospital admission, and are paid from the surgical or non-surgical pool; it is specialist consultations that are tied to a private hospital admission in base cover.

The Specialist Option removes that restriction, adding unlimited specialist consultations plus its own diagnostic benefits, capped at $3,000 a year for tests and $60,000 a year for cardiac investigations.

Easy Health ties specialist consultations to a hospital admission the same way, but has no Specialist Option to remove that restriction.

Affiliated Providers: how each insurer's network works

An Affiliated Provider is a provider contracted to deliver eligible services at agreed prices. There are three distinct network models across these six plans, not two, and the difference decides both what you pay and whether a service is covered at all.

The three models:

• nib's First Choice Network, on Ultimate Health and Easy Health. In-network you get 100% of eligible costs; out-of-network nib pays up to its Efficient Market Price and you pay the difference. You keep free choice of any qualified New Zealand provider either way, because the network affects the reimbursement level rather than eligibility.
• No network at all, on Ultimate Health Max. Its wording contains no First Choice Network and no Efficient Market Price. nib assesses claims against usual, customary and reasonable charges instead.
• Southern Cross's Affiliated Provider programme, where an AP settles directly with Southern Cross and arranges prior approval for you.

Southern Cross's Affiliated Provider programme works like this: it publishes a list of Affiliated Provider-only services, and the list expressly does not apply to UltraCare. On UltraCare, a non-Affiliated specialist is still covered, at reasonable charges.

On Wellbeing One and Wellbeing Two the list does apply. Services caught by it are not covered if a non-Affiliated Provider delivers them. It includes all specialist consultations except psychiatry, all chemotherapy and radiotherapy, and a named list of diagnostic imaging and cardiac tests. Many named surgical procedures are on it too. If keeping a particular specialist matters to you, that is the row to check before you switch.

Claims routes follow the same pattern. Southern Cross members have three routes. An Affiliated Provider settles directly, Easy-Claim settles at the point of service, or you pay and claim within 12 months.

With nib, pre-approval lets an in-network provider invoice nib directly, and the claim deadline is also 12 months.

How these plans work with ACC

ACC covers injuries from accidents, not illness, and that boundary is where both insurers' top-up benefits start. ACC's own wording is plain: "We won't cover things like illness, conditions from ageing and emotional issues." It also excludes most hernias, and gradual-onset injuries unless work is causing them.

If ACC does accept a claim, it often pays only part of the cost. The clearest example is elective surgery. If your surgeon holds an ACC Elective Surgery Services contract, ACC pays the contracted price in full. That covers the surgery and six weeks of post-discharge care, and you cannot be charged a co-payment. Where the provider is not contracted, ACC contributes 60% of the contracted cost.

ACC's 60% contribution to a non-contracted surgery leaves a gap an ACC top-up benefit is designed to help close. ACC is also legally required to tell you that the surgery could be done at no cost by a contracted supplier, even if that means a different surgeon.

Each insurer handles the top-up slightly differently:

• Ultimate Health Max and Ultimate Health carry both an ACC Top-Up Benefit and a separate ACC Treatment Injury Benefit. ACC must confirm its payment first, and any later ACC reimbursement is forwarded to nib.
• Easy Health carries the ACC Top-Up Benefit only, and excludes injuries that pre-date your join date.
• Southern Cross excludes ACC-covered services in general. It then pays an accident and treatment injury top-up once you have done everything reasonably possible to obtain ACC approval.

ACC covers a treatment injury where treatment directly caused the injury and it is not a normal side-effect of that treatment. That is precisely the gap Ultimate Health Max, Ultimate Health, and Southern Cross's treatment injury wording addresses; Easy Health carries no equivalent clause, only the ACC Top-Up Benefit.

Note that ACC does not publish anything about how it interacts with private insurers, so read the sequencing from your policy rather than from ACC.

Pre-existing conditions and underwriting

Both insurers exclude pre-existing conditions unless they have agreed to cover them, and both underwrite each applicant individually. An exclusion isn't necessarily permanent: declaring it, waiting it out on some plans, or a later review can lift it.

What differs is whether an exclusion can ever come off, and on what timetable. Policywise's guide to health insurance and pre-existing conditions covers the application process in more detail.

nib

nib defines a pre-existing condition as any sign, symptom, treatment, or surgery for a condition that existed on or before your join date. It must also be something you were aware of, or that would prompt a reasonable person to seek care. On Ultimate Health Max and Ultimate Health it is excluded unless you declare it and nib accepts it, with no time-based waiver anywhere in either wording.

Easy Health is the exception, and nib markets it as such. After a three-year standard waiting period, eligible pre-existing conditions become coverable.

Six categories stay permanently excluded regardless: cardiovascular conditions, cancer, hip or knee conditions, back conditions, transplant surgery, and reconstructive surgery predating your join date. A newborn added within four months of birth has pre-existing conditions covered on Ultimate Health Max under whichever Option the child is added to.

On Ultimate Health, cover extends to Base Cover plus whichever Option the child is added to. On Easy Health, cover is automatic under Base Cover.

Southern Cross

Southern Cross underwrites by medical declaration rather than a medical examination. It says pre-existing conditions are normally excluded, because health insurance is intended to cover conditions that arise after the policy starts. An application typically takes five to 10 working days.

The two plan families then diverge. On UltraCare, a pre-existing condition may become eligible after three years' continuous cover. On Wellbeing One and Wellbeing Two there is no fixed three-year rule. Your membership certificate shows an individually specified review period, after which you can request a review with medical documents.

What happens to your pre-existing conditions if you switch

Neither nib nor Southern Cross publishes a concession for switchers, so a condition you developed while insured elsewhere is underwritten as a pre-existing condition on the new policy. The IFSO puts it plainly: a new insurer "will probably consider these to be pre-existing conditions under the new policy," and claims relating to them could be declined.

Both insurers' own forms say the same thing in practice. nib's Ultimate Health Max and Easy Health application forms warn that acceptance terms may differ if your health has changed since the policy being replaced started. They also tell you to contact the old insurer to cancel.

Southern Cross's medical declaration asks whether the application replaces existing cover. It then advises you to understand the differences before you cancel, rather than promising continuity.

Southern Cross makes the consequence explicit in the context of a lapse. Conditions that developed while cover was stopped "would probably be excluded as 'pre-existing conditions'" if you restart, with Southern Cross or another insurer. Members leaving an employer scheme have 30 days to discuss retaining cover.

One clause looks like an exception and should not be read as one. Ultimate Health Max recognises a waiting period already served on "a policy nib considers comparable." The wording does not say whether that can be a rival insurer's policy, so do not assume it is.

Before you cancel anything, ask an adviser to compare the exclusions on your current certificate against what the new insurer would apply. Claims advocacy and underwriting support are part of what Policywise does after the policy is in place, not just before.

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