> _Markdown transcription of nib Ultimate Health policy wording, effective 2019-12-19. Source: https://www.nib.co.nz/Documents/Document/UltimateHealthBrochure.pdf_ --- # ULTIMATE HEALTH MAX™ & ULTIMATE HEALTH™ ## Introduction Introducing two of nib's most comprehensive and flexible private health insurance policies – Ultimate Health Max and Ultimate Health. These policies offer nib's very best cover and protection for a wide range of essential health treatments and the costs that go with them. With Ultimate Health Max and Ultimate Health you can choose a health specialist or provider you trust and if you need treatment, when and where you receive it. This can reduce unnecessary disruption to your life, stress, anxiety and possible wait times. These policies are available exclusively through your financial adviser. This brochure includes information about how a financial adviser can help you understand the choices available and how to select the cover that best meets your needs and those of your family. ## THE ULTIMATE SUITE ### ULTIMATE HEALTH MAX™ AND ULTIMATE HEALTH™ OFFER CONFIDENCE & CERTAINTY Both Ultimate Health Max and Ultimate Health offer choice, certainty of cover terms and flexibility. They cover treatment for a range of serious medical conditions as well as treatment for many of the more common, everyday health problems you might experience. Without private health insurance, the costs of these treatments and the associated consultations and scans can be substantial. ### Protection for all the family Need protection only for yourself? Or does your partner, children and extended family also need protection? Ultimate Health Max and Ultimate Health policies can include the whole family: husband and/or wife, partner, children, parents, grandchildren and grandparents. You can also add family members after the policy commences (e.g. on the birth of a child - there's even a benefit for newborns), or you can take out a policy just for your children, or grandchildren. ### Cover that meets everyone's needs The foundation of your health insurance cover is the Ultimate Health Max or the Ultimate Health Base Cover. The Base Cover provides protection for many of the big expenses like surgery and medical and cancer treatment in a private hospital. Options enhance the Base Cover. They cover different types of health services and provide extra levels of flexibility and protection. The policies are flexible. Everyone on your policy can have a different base cover, excess and options. No matter how many people are on your policy, everyone can get the cover they require. ### Certainty and clarity Ultimate Health Max and Ultimate Health policies are underwritten at the time of application, which means you disclose your medical history upfront and get certainty about what you are covered for. ### Getting help with making the right decision Your financial adviser can help you identify and prioritise your health protection needs. Financial advisers are experienced specialists, understand health insurance and offer expert knowledge. ## PERSONALISE YOUR HEALTH INSURANCE ### 1. First choose your Base Cover and excess Each person can choose either the Ultimate Health Max or Ultimate Health Base Cover. To help reduce premiums without sacrificing essential benefits, each person also chooses an excess and the related premium discounts. The excess applies to the claims each person makes under their Base Cover in the policy year, unless otherwise specified. Once their excess amount has been reached, nib will pay any further eligible claims within that policy year. ### Excess alternatives and related premium discounts | Excess | Discount | |--------|----------| | NIL | 0% | | $250 | 10% | | $500 | 25% | | $1,000 | 35% | | $2,000 | 45% | | $4,000 | 55% | | $6,000 | 60% | *The level of discount may be changed from time to time. Discounts shown apply to single-life policies, the discount may vary for policies with multiple lives insured. Discounts shown apply to the entire Premium of the single-life policy. ### 2. Then choose your Additional Options These Options enhance your protection in the areas that are important to you. Details of each Option are included on the following pages. Your financial adviser will explain each of the Options and the additional costs associated with them. **Note:** The Excess each person chooses with their Base Cover does not apply to claims made under any of the Additional Options that they choose. #### Available Options: - Specialist Option - GP Option - Dental & Optical Option - Serious Condition Financial Support Option - Proactive Health Option ## BASE COVER SUMMARY Your Base Cover ensures you have cover for surgical and medical (non-surgical) treatments in a private hospital. Importantly, the Base Cover pays for many of the costs directly and indirectly associated with these treatments. ### Ultimate Health Max™ – Base Cover The Ultimate Health Max Base Cover includes all the benefits of Ultimate Health Base Cover - as well as some important additional benefits designed to increase your protection and to provide you with greater peace of mind. The Ultimate Health Max Base Cover includes any future policy upgrades and policy benefits are guaranteed. Together, this means your cover will automatically be improved if favourable new benefits or enhancements are made to the Base Cover. Importantly, nib can only change your cover if requested by you or under other limited circumstances. This will also apply to any Additional Options you select as part of your cover. For many people, choosing a treatment provider they can trust is important. With Ultimate Health Max, you can choose any recognised health provider and be covered for 100% of actual costs, regardless of the provider's nib First Choice network* status (subject to the benefit limits and the terms of the policy and less any applicable policy excess). New, more effective medicines are being developed every day but some are expensive and some are not subsidised by the government, especially when they are first available. This can put them out of the reach of many people needing treatment. Ultimate Health Max includes additional cover for non-PHARMAC funded drugs (in hospital or at home), up to the Hospital Surgical or Hospital Medical benefit maximums. Ultimate Health Max helps ensure access to the best range of treatment available. It's another reason why Ultimate Health Max is such a popular choice. *For more information about the nib First Choice network, please refer to page 17 ### Ultimate Health™ – Base Cover With Ultimate Health Base Cover you'll be covered for 100% of actual costs for treatment (subject to the benefit limits and the terms of the policy, less any applicable policy excess) when you use an nib First Choice provider*. You can still choose to be treated by a recognised provider who is not part of the First Choice network and nib will pay the Efficient Market Price (EMP) for the health services they provide, less your applicable excess and up to the benefit limit. However you will be responsible for paying the difference between the amount the provider charges and what nib pays. The Ultimate Health Base Cover includes cover for surgical and medical (non-surgical) treatments in a private hospital. Cancer treatment and treatment for other potentially life-threatening health conditions such as strokes and heart attacks are covered. Surgery carried out by a GP is also included, for example, mole removal. Surgical and medical treatments often include the need for scans, consultations with specialists, medication, dressings, rehabilitation and of course a stay in a private hospital with nursing care and meals. These costs are included under the Base Cover provided they are a necessary part of the surgery and occur within 6 months of the hospital admission itself. Many other ancillary costs are also covered, some of these are specific to the treatment required, such as counselling and support as part of cancer treatment. Others such as travel and accommodation (including an allowance for a support person) are included when treatment is not available locally. Base Cover also includes cover for conditions like cataracts, grommets or varicose veins, that may not be considered life threatening but which can be expensive to treat, and if left untreated, can significantly impact your comfort and quality of life. Sometimes you may think you have the early signs of a health problem and as part of the diagnosis, you are sent for tests or scans. When the news is good and no surgery or treatment is required, you'll also be reassured to know that there is a benefit that provides cover for major diagnostic investigations, whether hospitalisation is required or not. There is also a benefit covering follow up investigations for up to five years after cancer treatment. *For more information about the nib First Choice network, please refer to page 17. ## ADDITIONAL OPTIONS These Additional Options can be included with your Ultimate Health Max or your Ultimate Health Base Cover. If you have chosen the Ultimate Health Max Base Cover, any Additional Options you choose will also include the Ultimate Health Max future policy upgrades and guaranteed wording. ### Specialist Option Covers you for an unlimited number of specialist consultations and diagnostic procedures that don't result in hospitalisation. These diagnostics include X-rays, arteriograms, ultrasounds, scintigraphy, mammography and visual field tests. This option covers cardiac investigations, including cardiovascular ultrasounds, echocardiography and treadmill tests for up to $60,000 each policy year. **COVERS UP TO 100% OF THE COST UP TO THE BENEFIT LIMITS. YOU WON'T PAY ANY EXCESS FOR CLAIMS UNDER THIS OPTION.** ### Serious Condition Financial Support Option A one-off lump sum payment is made to help reduce the financial strain of dealing with specific trauma conditions. You can use this lump sum on whatever you wish; for expensive out-of-hospital drug treatments, rehabilitation expenses, paying off the mortgage or maybe a holiday to recuperate. You can be insured for either $20,000 or $50,000. The Option covers 39 trauma conditions* including strokes, life-threatening cancers and major heart attacks. If you have this option, there is free Serious Condition Financial Support cover for your children. You won't pay an excess for a claim under this option. *Some of the trauma conditions covered have a waiting period of 90 days. If any of these conditions (including signs and symptoms) occur within the first 90 days on this option, or subsequently reoccur, that condition won't be covered under this option. ### GP Option Perfect for those wanting to cover day-to-day healthcare costs. Particularly useful if a health problem develops and requires regular GP consultation. This Option covers up to twelve GP consultations plus cover for nurse visits, prescriptions and physiotherapy. There's also an Active Wellness Benefit. Covers 100% of the cost up to the benefit limits. A waiting period of 90 days applies. You won't pay any excess for claims under this option. ### Dental & Optical Option Ideal for trips to the dentist, chiropractor, podiatrist or osteopath. Or when you need glasses or contacts. There are also benefits covering acupuncture, as well as speech, occupational and eye therapy. Covers 80% of the cost up to the benefit limits. A waiting period of six months applies. You won't pay any excess for claims under this option. ### Proactive Health Option Encourages you to take proactive steps to look after your health, whether you want to check any hereditary medical concerns or you just want to stay fit and healthy. You'll be covered for screening, such as breast screening, prostrate screening, heart screening and mole mapping, allergy testing and vaccinations, gym memberships, weight loss management programmes, quit smoking programmes and routine health checks. The premium for this option is one set price regardless of your age, gender or smoking status. Plus you'll get up to a maximum of $1,400* worth of cover a year. Covers 80% of the cost up to the benefit limits. A waiting period of six months applies. You won't pay any excess for claims under this option. *Sub limits apply ## OVERVIEW OF BENEFITS, FEATURES AND LIMITS OF ULTIMATE HEALTH MAX™ & ULTIMATE HEALTH™ ### Key differences between: Ultimate Health Max™ and Ultimate Health™ | Feature | Ultimate Health Max™ | Ultimate Health™ | |---------|----------------------|-----------------| | Individual's medical history is asked | At application | At application | | Guaranteed benefits and future upgrades | ✓ | Not guaranteed | | Cover for Pre-existing conditions | No cover | No cover | | Application of excess | Per person per year | Per person per year | | Flexibility to choose a different Base Cover for each person on one policy | ✓ | ✓ | | Flexibility to choose a different excess level for each person on one policy | ✓ | ✓ | | Flexibility to choose different options for each person on one policy | ✓ | ✓ | | **Basis of cover** | | | | Services and treatment provided by an nib First Choice network provider | Actual costs | Actual costs | | Services and treatment by a provider that is not part of the First Choice network | Actual costs | EMP¹ | | Services and treatment that are not subject to the First Choice network | Actual costs | Actual costs | ### Base Cover | Benefit | What is covered | Ultimate Health Max™ | Ultimate Health™ | |---------|-----------------|----------------------|-----------------| | Hospital surgical benefit | Cover for private hospital surgical costs | Up to $600,000 | Up to $600,000 | | Hospital medical benefit | Cover for private hospital medical costs | Up to $300,000 | Up to $300,000 | | Cancer treatment in hospital benefit² | Cover for surgical and medical cancer treatments | ✓ | ✓ | | Non-PHARMAC funded drugs in hospital benefit | Cover for non-PHARMAC funded drugs for surgical and medical treatment in hospital | ✓ | Up to $20,000 for chemotherapy drugs only | | Non-PHARMAC drugs at home benefit² | Cover for non-PHARMAC funded drugs for use at home up to 6 months after hospitalisation | ✓ | | | Breast symmetry post mastectomy benefit² | Cover for unilateral breast reconstruction and / or reduction surgery following a mastectomy | ✓ | ✓ | | Cancer treatment accessories support benefit² | Cover towards the cost of a wig, hat, scarf or mastectomy bras during or within 6 months after cancer surgery or treatment | ✓ | No cover | | Cancer treatment counselling and support services benefit² | Cover for counselling and support services within 6 months after cancer surgery or treatment | ✓ | No cover | | Cardiac counselling and support services benefit² | Cover for counselling and support services within 6 months after heart surgery | ✓ | No cover | | Follow-up investigations for cancer benefit² | Up to $3,000 for follow-up investigations for up to 5 years after cancer treatment | ✓ | ✓ | | Major diagnostics benefit² | Cover for major diagnostic investigations whether hospitalised or not e.g. CT scans, MRI scans, PET scans, Colonoscopies and Gastroscopies | ✓ | ✓ | | Hospital diagnostics benefit² | Cover for diagnostic investigations up to 6 months before and after hospitalisation | ✓ | ✓ | | Hospital Specialist Consultations Benefit² | Cover for specialist or vocational GP consultations up to 6 months before and after hospitalisation | ✓ | ✓ | | Hospital specialist second opinion benefit² | Cover for specialist consultations for a second opinion up to 6 months before and after hospitalisation | ✓ | ✓ | | Travel and accommodation benefit²,³ | Travel costs for you and a support person, and accommodation costs for a support person when you need to travel further than 100km from where you live for treatment | ✓ | ✓ | | Parent accommodation benefit² | Up to $3,000 for a parent's accommodation if a child is hospitalised – a GP or specialist recommendation is not required | ✓ | ✓ | | Ambulance transfer benefit² | Covers for cost of road ambulance transfer from a public hospital or private hospital to the closest private hospital | ✓ | ✓ | | Home nursing care benefit² | Up to $6,000 for home nursing for up to 6 months after hospitalisation | ✓ | ✓ | | Physiotherapy benefit² | Cover for physiotherapy up to 6 months after hospitalisation | ✓ | ✓ | | Therapeutic care benefit² | Up to $1,000 for osteopathic, chiropractic and sports physician treatment, speech and occupational therapy, and dietitian consultations for up to 6 months after hospitalisation | ✓ | ✓ | | Delayed care benefit² | Cover available overseas if an insured person has to wait for treatment in New Zealand for 6 months or longer due to insufficient medical resources | ✓ | ✓ | | Cover in Australia benefit² | Up to either the EMP¹ or UCR charges⁴ for specific diagnostic investigations and treatment costs incurred in Australia | UCR charges⁴ | EMP¹ | | Overseas treatment benefit | Top-up for treatment that is not available in New Zealand and when funding has been declined by the Ministry of Health, up to the specified benefit limit | Up to $30,000 per visit | Up to $30,000 per visit | | Medical tourism benefit² | Up to 75% of UCR charges⁴, if an insured person elects to have treatment overseas, provided the treatment is available in New Zealand within 6 months | ✓ | No cover | | Obstetrics benefit | Cover for treatment by an obstetrician for each pregnancy when recommended by your doctor | Up to $4,000 | Up to $2,000 | | Podiatric surgery benefit | Up to $6,000 for podiatric surgery including one pre and one post consultation and associated X-rays | ✓ | ✓ | | Pre-existing cover for newborns benefit² | Cover for pre-existing conditions (other than congenital) for dependent children when added within 4 months of birth | ✓ | ✓ | | Public hospital cash benefit | Up to $3,000 cash payment when admitted to a public hospital for 3 or more consecutive nights | ✓ | ✓ | | Hospice care benefit | Up to $3,000 when admitted to a hospice for 3 or more consecutive nights | ✓ | No cover | | Intravitreal eye injections benefit | Up to $3,000 for intravitreal eye injections | ✓ | ✓ | | Specialist skin lesion surgery benefit | Cover for specialist skin lesion surgery up to the specified benefit limit | ✓² | Up to $6,000 | | GP minor surgery benefit | Cover for GP minor surgery up to the specified benefit limit | Up to $5,000 | Up to $1,500 | | ACC top-up benefit² | Covers the difference in costs between what is payable by ACC for an injury and the costs incurred | ✓ | ✓ | | ACC treatment injury benefit² | Cover for reparative treatment for any injury that occurs during treatment | ✓ | ✓ | | Medical misadventure benefit | $30,000 lump sum payment in case of death due to medical misadventure | ✓ | ✓ | | Funeral support benefit | A lump sum payment if an insured person dies between the age of 16 and 64 | $10,000 | $5,000 | | Premium waiver benefit | Up to 2 years of premium waiver if the policyowner dies before age 70 | ✓ | ✓ | | Premium waiver extension benefit | Up to 6 months premium waiver if the policyowner is diagnosed with a terminal illness before age 70 | ✓ | No cover | | Loyalty benefit – suspension of cover | Cover can be suspended for the specified circumstances after 12 months of continuous cover | Travels overseas, takes parental leave, becomes unemployed or redundant | Travels overseas, takes parental leave, becomes unemployed or redundant | | Loyalty benefit – sterilisation | Covers a sterilisation procedure after 2 years of continuous cover, up to the specified benefit limit | ✓² | Up to $1,000 | | Loyalty benefit – bariatric surgery² | Up to a lifetime limit of $10,000 for the cost of bariatric surgery, after 3 years of continuous cover. | ✓ | No cover | | Loyalty benefit – bilateral breast reduction² | Up to a lifetime limit of $10,000 for the cost of bilateral breast reduction surgery, after 3 years of continuous cover | ✓ | No cover | | Loyalty benefit – wellness | Up to $100 for a medical examination by a GP every 3 years for each adult, after 3 years of continuous cover | ✓ | ✓ | **Benefit limits apply to each insured person every policy year unless otherwise specified. If an excess is chosen, this applies to the Base Cover only** ¹ Efficient Market Price. ² Any related costs paid under this benefit are deducted from the balance available in the benefit maximum for the Hospital Surgical Benefit or Hospital Medical Benefit (whichever applies) in each policy year. ³ Individual sub-limits apply for both travel and accommodation and vary depending on the treatment received. ⁴ Usual, Customary and Reasonable charges. **Note:** This overview is not a policy document. It is an outline of the benefits of nib's Ultimate Health Max and Ultimate Health products. A full explanation of the benefits, exclusions and general terms are contained in the policy documents. A copy of each policy document is available at nib.co.nz ### Additional Options | Option | What is covered | Ultimate Health Max™ | Ultimate Health™ | |--------|-----------------|----------------------|-----------------| | **Specialist Option** | | | | | | Unlimited registered specialist or vocational GP consultations | ✓ | ✓ | | | Unlimited registered specialist or vocational GP consultations for a second opinion | | | | | Up to $500 for registered sports physician treatment | | | | | Up to $3,000 for any diagnostic investigations e.g. X-rays, arteriograms and ultrasounds | | | | | Up to $60,000 for cardiac investigations e.g. treadmills, holter monitoring, cardiovascular ultrasounds and myocardial perfusion scans | | | | | Cover for pre-existing conditions (other than congenital) for dependent children when added within 4 months of birth | | | | **Proactive Health Option⁷** | | | | | | Up to $750 for the following health screening tests: bone, bowel, breast, cervical, heart, prostate, eye / visual field, hearing and mole mapping | ✓ | ✓ | | | Up to $100 for allergy testing and vaccinations | | | | | Up to $300 for dietitian or nutritionist consultations | | | | | Up to $100 towards gym memberships, weight-loss management programmes and quit smoking programmes | | | | | Up to $150 for a full health check by a GP, at the end of every 2 years of cover under this option | | | | **Serious Condition Financial Support Option** | | | | | | One-off lump sum payment if you are diagnosed with one of a number of serious conditions (as defined) | 39 conditions | 39 conditions | | | Choice of cover: $20,000 or $50,000 | ✓ | ✓ | | | An additional lump sum payment for paralysis (as defined), equal to the amount of the sum insured | ✓ | ✓ | | | Up to 50% of the sum insured is paid if an insured person's child (between the age of 2 to 20, whether or not they are on the policy) suffers one of the defined serious conditions | ✓ | ✓ | | **GP Option** | | | | | | Up to 12 GP consultations | ✓ | ✓ | | | Up to $200 for each GP minor surgery | | | | | Up to $300 for pharmaceutical prescriptions | | | | | Up to $400 for physiotherapy | | | | | Up to 6 nurse practitioner visits | | | | | Up to $150 towards the cost of sports clubs, gym memberships, or fitness equipment purchased after 2 years of continuous cover under this option (if claims have been less than $150) | | | | | Cover for pre-existing conditions (other than congenital) for dependent children when added within 4 months of birth | | | | **Dental and Optical Option** | | | | | | Up to $500 for dental examinations, cleaning, scaling, fillings, associated X-rays, removal of teeth and crowns | ✓ | ✓ | | | Cover for orthodontic treatment included in the dental care benefit maximum of $500, after 2 years continuous cover under this option | | | | | Up to $275 for optometrist, orthoptist and optician consultations / examinations | | | | | Up to $330 for prescription glasses or contact lenses if there is a change of vision | | | | | Up to $250 for audiometric tests and $250 for audiology treatment | | | | | Up to $250 for acupuncture treatment | | | | | Up to $250 for chiropractic treatment and $80 for related X-rays | | | | | Up to $250 for osteopathy treatment and $80 for related X-rays | | | | | Up to $250 for podiatry treatment | | | | | Up to $300 for speech therapy, occupational therapy and eye therapy | | | | | Cover for pre-existing conditions (other than congenital) for dependent children when added within 4 months of birth | | | ⁷ This option covers any pre-existing conditions after the applicable waiting period has been served. **Note:** This overview is not a policy document. It is an outline of the benefits of nib's Ultimate Health Max and Ultimate Health products. A full explanation of the benefits, exclusions and general terms are contained in the policy documents. A copy of each policy document is available at nib.co.nz ## PERSONALISE YOUR COVER ### The Barker Family Health Cover An example of cover tailored to a family's specific needs The example shows how different family members on the same policy can have different Base Covers, Excesses and Additional Options. It means your family health insurance is right for each family member. Importantly it also means you only pay for what the family needs and overall costs are reduced, sometimes significantly. **Mr Barker** - Ultimate Health Max - $500 excess - Specialist Option - Dental & Optical Option **Mrs Barker** - Ultimate Health Max - $500 excess - Serious Condition Financial Support Option **Richard Jnr. Barker** - Ultimate Health - $250 excess - GP Option **Jessica Barker** - Ultimate Health - nil excess - Specialist Option ## WHY nib? nib provides value for money and affordable health cover to over one million Kiwis and Aussies. Established over 60 years ago, nib is a truly trans-Tasman business that offers innovative covers and services and greater value for our customers. With thousands of New Zealand customers, we know about the cover Kiwis and their families need, so we've designed a range of health insurance policies to suit. At nib we believe that health insurance should be easy to understand, easy to claim on and great value. ### Claiming is easy Our core business is paying claims and being there when you need us most. On average every week nib pays over $2.2 million in claims*. We're assisting New Zealanders who need treatment and who might otherwise be struggling with both illness and strained financial circumstances. We aim to make the claims process as hassle-free as possible. Claims and pre-approvals can be submitted by your treatment provider on your behalf with the nib First Choice Portal. Or you can submit claims yourself through the nib portal or with the free my nib app. *Between January – December 2016. ### Commencing your cover You can choose whether to have your cover start shortly after we process your application, or at a set date up to six weeks later. ### 14-day free-look period To give you time to consider your policy, nib provide a 14-day free-look period. During this time if the policy isn't right, it can be cancelled and nib will refund any premiums paid, providing no claims have been made. ### Premium payment alternatives nib offers a range of different payment options including direct debit or credit card, and various payment frequencies including weekly, fortnightly, monthly, quarterly, half-yearly or yearly. ## nib's FIRST CHOICE NETWORK The nib First Choice network is a network of health service providers that treat nib clients within nib's First Choice price range. nib established the network to help manage claims costs and premium increases over time. Health service providers are able to lodge pre-approvals and claims on behalf of policy holders, reducing effort for clients and speeding up payments. To learn more about the network and search for providers in your area visit the nib First Choice Directory at nibfirstchoice.co.nz/directory ## THE IMPORTANCE OF PRIVATE HEALTH INSURANCE Your health is one of your greatest assets – it helps you earn an income, support your family and enjoy life. Private health insurance is an investment in your quality of life. ### 7 reasons for having comprehensive health insurance **1. Greater choice** You choose who you receive treatment from, and with your GP or Specialist, you decide when and where. Being able to choose reduces uncertainty and enables you to make plans and minimise disruption. **2. Less waiting** While you're waiting for treatment your health could be deteriorating and secondary effects could be developing. If you're in pain, waiting can be difficult and emotionally draining. **3. Less worry** People often worry when they are waiting for treatment and so do the people who love and support them. Reducing waiting time can reduce worry time. **4. Less lost income - financial support** Bad health could result in time off work and lost income for you or a supportive family member. And if you're paying for treatment yourself, that's an additional financial burden. **5. Access to leading edge treatments** Health practices and treatments are advancing rapidly. Private health insurance can give you access to treatments that you may not otherwise be able to afford. **6. Preventative care** With the Proactive Health Option, it's easier to stay healthy, and to enjoy life and all the things you've worked hard for. **7. Increased certainty and confidence about the future** Private health insurance provides you with greater certainty about access to support and treatment when you need it. With Ultimate Health Max's upgrade entitlement and guaranteed wording, your cover can also keep up with health insurance innovations and improvements. ## TRUE COST OF HEALTH CLAIMS This is an illustration of treatments and costs you could expect to pay if treated in private hospital. This is not representative of conditions covered on your policy or the amount that would be paid by nib nz limited in the event of a claim. ### Cancer treatments - Removal of cancerous skin lesion: $1,000 – $6,500 - Chemotherapy: $15,000 – $170,000 per treatment cycle - Radiotherapy: $20,000 – $37,000 per treatment cycle ### Children 0-20 years - Grommets: $500 – $3,500 (Insertion of tubes in the eardrums) - Adenotonsillectomy: $4,000 – $5,500 (Surgical removal of adenoids and tonsils) ### Diagnostics - PET Scan: $2,000 – $2,800 - MRI Scan: $1,300 – $1,700 - CT Scan: $1,300 – $1,700 - Ultrasound: $400 – $500 ### Head and Neck - Cataract surgery: $4,300 - $5,200 (Removal of the cloudy lens from the eye affecting vision) - Endoscopic sinus surgery: $12,000 - $37,000 (Surgical repair of the facial sinuses) - Wisdom teeth removal: $3,000 – $5,500 (Surgical removal of wisdom teeth (third molars)) - Thyroidectomy: $11,000 to $15,000 (Surgical removal of the thyroid gland) ### Heart and Vascular - Angioplasty: $17,300 – $27,400 (Insertion of a catheter to unblock artery with a stent or balloon) - Single valve heart operation: $48,000 – $60,000 (Surgery to repair or replace a heart valve) - Heart bypass: $35,000 – $50,000 (An operation to rechannel blood flow to the heart) ### Breast - Mastectomy: $12,000 – $15,000 (Surgical removal of the breast) ### Spinal and Abdominal - Spinal fusion: $20,000 – $60,000 (Surgery to join two or more vertebrae together) - Gastroscopy: $1,100 – $1,600 (A diagnostic procedure to look at the mouth, throat and stomach) - Cholecystectomy: $8,500 – $13,000 (Surgical removal of the gall bladder) - Colonoscopy: $2,000 – $2,500 (A diagnostic procedure to look at the large bowel and sample tissue) - Hysterectomy: $13,000 - $19,300 (Surgical removal of the uterus) - Appendectomy: $6,000 – $10,300 (Surgical removal of the appendix) - Hernia repair: $7,000 – $18,000 (Surgical repair of weakness in the abdominal wall) - Resection of endometriosis: $9,000 – $25,000 (Surgical removal of the uterine cells from the pelvis or abdomen) ### Joints and Limbs - Total hip joint replacement: $20,000 – $27,000 (Replacement of the hip joint with an artificial joint) - Total knee joint replacement: $22,000 – $30,000 (Replacement of the knee joint with an artificial joint) - Varicose veins (both legs): $7,000 – $10,000 (Laser or surgical removal of varicose veins) ### Prostate - Robotic Prostatectomy: $30,000 – $45,000 (Robotic surgical removal of the prostate) For more information talk to your adviser. ## THE BENEFITS OF GETTING HELP FROM A FINANCIAL ADVISER Many people find financial issues and decisions overwhelmingly complex, particularly when they are balancing short and long-term needs and what they can afford. A financial adviser will help simplify the process and the decisions and will do most of the work necessary to keep the process moving, while you get on with your life. Financial advisers work independently of nib and have various ways of advising their clients. ### Understanding your circumstances When you talk to a financial adviser, they'll probably start by describing how they usually work with clients. They'll also want to understand your situation and the services you need. You might want to focus just on health insurance or you might be interested in how they can help you with other financial services such as life insurance, obtaining a mortgage or investment advice and KiwiSaver. ### Clarifying needs and prioritising Your adviser will work with you to help prioritise your immediate and your longer term financial needs and goals, taking into consideration the needs of your partner and children, if applicable. Your financial adviser can simplify what could otherwise be a quite complex process. ### Decision time You'll have some choices to make. Health insurance is usually part of a financial adviser's recommendation, because an ongoing health condition can mean ongoing loss of income and ongoing costs. Your financial adviser will recommend cover options that meet the needs of you and your family. This is an area where their specialist expertise is invaluable. ### Application You'll need to fill in some forms. The information you provide is important and must be complete and accurate. nib will assess your application and advise if there are any exclusions that will apply (usually related to health issues in the past). Your financial adviser will explain these and help you decide the best way forward. ### Suppose you need to make a claim It's good to know you're covered with nib when you need to make a claim. Your adviser can help you with pre-approval and making a claim if you wish, so you can focus on recovering. Claims can be made through your provider, online or in a snap with the my nib app. ### Your annual 'health insurance check-up' A lot can change in a year, so it's important to review your cover to check it still suits your needs. This annual check-up is part of the service many advisers provide and is a good time to see if there are any opportunities to save you money. ### This is how your financial adviser might work with you 1. You and your adviser engage and agree on the services you require 2. You and your adviser clarify your financial needs and priorities 3. Your adviser researches possibilities and alternatives 4. Your adviser offers alternatives and recommendations. You decide 5. Your adviser implements your decisions 6. Your adviser makes sure your protection is still meeting your needs ## A FEW THINGS TO KEEP IN MIND Nobody likes to think they'll experience health problems, but the reality is, many will. ### The public health system isn't always able to provide immediate care For non-critical health problems, even serious ones like a heart condition, you could face waiting lists. It may take several months to be treated. ### ACC only goes so far Many people mistakenly assume that ACC will take care of them if they become ill. But ACC doesn't provide for treatment associated with illness or ageing or for conditions that are considered to be due to gradual deterioration or wear. One of the benefits of Ultimate Health Max and Ultimate Health is a top up for your surgical or non-surgical ACC claims. ### Self-insuring can be financially challenging Rather than taking out health insurance, some people believe they could afford to pay for private treatment themselves. With many hospital procedures now costing over $20,000, self-insuring can prove really tough. Having to pay for hospital treatment yourself can often mean: - Taking out or increasing a loan - Using savings or retirement funds - Selling assets - Borrowing from family If you have to pay for a series of expensive treatments, the cumulative costs can be daunting. ## GLOSSARY OF IMPORTANT TERMS At nib we aim to explain information about our insurance products in a language our customers will understand. Below are explanations of some of the terms we use, but you are welcome to speak to us, or your financial adviser, if you need help with any of the words used in this brochure. ### Benefit limit The maximum amount nib will pay for each benefit, for each insured person every policy year. ### Claim A request for the payment of benefits covered under your policy. ### Diagnostic investigation An investigative medical procedure undertaken to determine the presence or causes of a sign, symptom or medical condition. ### Excess The amount of money you will need to contribute each policy year towards the cost of investigations or treatment claimed by each insured person under your policy. ### Hospitalisation / hospitalised Admission in New Zealand to a recognised private hospital to undergo a surgical procedure or for receiving medical treatment, chemotherapy or radiotherapy treatment. ### Medical (non-surgical) treatment When a person undergoes a form of medical treatment using drug treatment which does not involve surgery (e.g. asthma, diabetes or epilepsy). ### Medsafe New Zealand Medicines and Medical Devices Safety Authority, a Business unit of the Ministry of Health with responsibility for administering the Medicines Act 1981 and the Medicines Regulations 1984 (or its successor under any subsequent legislation). ### nib First Choice network The nib First Choice network features nib recognised health service providers that provide our customers with services and treatment within nib's First Choice price range, meaning you will have 100% of your approved costs covered (up to your benefit limit and in line with your policy). ### PHARMAC The Pharmaceutical Management Agency is a Crown entity. PHARMAC's objective, as outlined in the New Zealand Public Health and Disability Act 2000, is to secure for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the funding provided (pharmac.govt.nz). ### Pre-approval for a claim Advanced confirmation of the eligibility of a claim prior to an insured person undergoing treatment, surgery or a diagnostic investigation. ### Premium The amount of money you pay to keep your insurance active. It can be paid weekly, fortnightly, monthly, quarterly, half-yearly or yearly. This includes any policy fee that may apply to your policy. ### Public health service or hospital Healthcare or hospitalisation which is funded by the government and used by the public. ### Recognised private hospital A private hospital, day surgery unit, or private wing in a public hospital, within New Zealand that is recognised by nib. ### Surgical / surgery An operation performed under anaesthetic (e.g. general surgery, oral surgery or cardiac surgery). ### Underwritten / underwriting When your medical information provided to us in the application form is assessed by an underwriter. The underwriter determines the terms on which nib will offer insurance to you. On some occasions, an exclusion or an additional premium may be applied due to a pre-existing condition. --- This brochure is not a policy document. It is an outline of the main features and benefits of the nib Ultimate Health Max and Ultimate Health policies. A full explanation of the features, benefits and exclusions are contained in the policy documents. Copies of the policy documents are available at nib.co.nz ## NEED HELP? Speak to your financial adviser or call nib on 0800 123 642 Go to nib.co.nz Email us at needadvice@nib.co.nz © 2018 nib nz limited