Cancer Cover NZ Health Insurance
Not every NZ health insurance plan covers high-cost non-Pharmac cancer drugs like Keytruda or Opdivo. The treatment gap between insurers is substantial — here's how each one handles cancer cover.
Cancer Cover NZ Health Insurance
NZ Pharmac funds some cancer drugs but not all. High-cost non-Pharmac drugs (Keytruda, Opdivo, etc.) and many newer immunotherapies are private-pay unless your health insurance has a specific non-Pharmac benefit. This page compares how every NZ health insurance product handles cancer treatment.
23 active retail products from 6 insurers
Looking for the topic comparison? /topics/oncology-high-cost-drugs/ shows the cross-insurer breakdown for this topic on a single page.
How each insurer covers this
Each section below is verbatim from the insurer's current policy wording PDF. Where a product doesn't address this specifically, we show "Not on file" rather than guess.
Easy Health
Wording effective 2019-12-19 · confidence no data
No specific rule for this topic on file.
Source: https://www.nib.co.nz/Documents/Document/EasyHealthBrochure.pdf
Ultimate Health
Wording effective 2019-12-19 · confidence no data
No specific rule for this topic on file.
Source: https://www.nib.co.nz/Documents/Document/UltimateHealthBrochure.pdf
Ultimate Health Max
Wording effective 2018-12-23 · confidence no data
No specific rule for this topic on file.
Source: https://www.nib.co.nz/Documents/Document/UltimateHealthMaxPolicyDocument20170701.pdf
AA Health Everyday Cover
Wording effective 2026-05-16 · confidence inferred
Under the GP and Prescriptions Benefit, only pharmaceutical prescriptions for medicines that are funded by PHARMAC at the time of your treatment are covered. Medicines that aren't funded by PHARMAC at the time of your treatment are explicitly excluded.
AA Private Hospital Cover
Wording effective 2023-10-01 · confidence inferred
Non-PHARMAC Cancer Treatment Benefit (Base Cover): covers chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC at the time of treatment, up to $10,000 per insured person per policy year, deducted from the overall benefit limit. Medicines must be Medsafe-approved and used within Medsafe approval; excludes medicines administered or charged in a public hospital and medicines not approved by Medsafe. Non-PHARMAC Plus Option (optional): covers non-PHARMAC, Medsafe-approved medicines (used within Medsafe approval) in a private hospital or at home for up to six months after a covered private hospital admission, up to the selected benefit limit per policy year; no excess applies to this Option; requires specialist referral and a recommendation letter from the specialist; must relate to an accepted claim under Surgical, Non-Surgical, or Cancer Treatment Benefit.
Relevant sublimits (NZD)
- non pharmac cancer treatment $10,000
AA Private Hospital + Specialist Cover
Wording effective 2026-05-16 · confidence inferred
Under the base Non-PHARMAC Cancer Treatment Benefit, chemotherapy or immunotherapy medicines administered in a private hospital that are not PHARMAC-funded are covered up to $10,000 per insured person per policy year (deducted from the Non-Surgical Benefit limit); Medsafe approval required. The optional Non-PHARMAC Plus Benefit covers non-PHARMAC, Medsafe-approved medicines (including high-cost cancer drugs) used in a private hospital or at home for up to six months post-admission, up to the selected benefit limit per insured person per policy year, with no excess; requires specialist referral and a recommendation letter explaining reasons for prescribing.
Health Positive
Wording effective 2016-01-22 · confidence no data
No specific rule for this topic on file.
Hospital Select
Wording effective 2018-01-25 · confidence no data
No specific rule for this topic on file.
ParentStay
Wording effective 2025-10-01 · confidence inferred
All prescription drugs and medication covered under the policy must be: registered and approved by Medsafe for use in New Zealand; prescribed and used within the guidelines set by Medsafe; Pharmac-approved and listed on the Pharmac Schedule under sections A to H, for the treatment being received in New Zealand; medically necessary; and prescribed by the treating specialist or GP. If the prescription drug requires special authority from Pharmac, confirmation that the member meets the special authority criteria is required before cover can be assessed. Under the Cancer Care benefit, only Pharmac-approved prescription drugs are covered. Non-Pharmac-funded drugs are not covered.
Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/ParentStay-Health-Plan-2025.pdf
UniCare Advantage
Wording effective 2025-08-01 · confidence low
Non-Pharmac chemotherapy drugs that are Medsafe approved for the treatment of cancer are covered up to $8,500 per annum, included within the overall Chemotherapy benefit of $55,000 per policy year. Genetic/genomic testing is also included, payable following a cancer diagnosis and referral by a Registered Oncologist.
Related exclusions (1)
- Surveillance following cancer is not available for skin cancers/lesions removed by a minor surgery procedure performed by a specialist in their specialist room or a general practitioner in their practice room.
Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/UniCare_Advantage_Plan.pdf
KidSmart
Wording effective 2026-05-16 · confidence inferred
Chemotherapy drugs administered orally at home, prescribed by a registered medical specialist and used during an approved cycle of chemotherapy treatment, are covered under the private hospital medical admission benefit (up to $300,000 per child per policy year). Non-Pharmac subsidised drugs (including cancer drugs registered by Medsafe but not Pharmac-funded) are covered under the non-Pharmac subsidised drugs benefit, with costs included within the maximum limit of the applicable surgical or non-surgical benefit. Up to $2,000 per child per policy year is provided for personal accessories needed during or within 6 months after cancer treatment (e.g. wig, hat, scarf).
SmartCare
Wording effective 2026-05-16 · confidence inferred
Non-surgical cancer treatment (including chemotherapy and radiation) is covered under the private hospital medical admission benefit, limited to $65,000 per person per policy year (included within the $200,000 benefit limit). Chemotherapy drugs administered orally at home, prescribed by a registered medical specialist and used during an approved cycle of chemotherapy treatment under the policy, are also covered. $2,000 per person per policy year is available for personal accessories needed during or within 6 months after cancer procedure or treatment (e.g. wig, hat, scarf, mastectomy bra). Oncology consultations and treatment following surgery are covered under the private hospital medical admission benefit. Prescription drugs must be Pharmac-approved and listed in sections A–I of the Pharmac Schedule; non-Pharmac drugs are not covered under the prescription drug benefit.
SmartCare+
Wording effective 2026-05-16 · confidence inferred
Non-Pharmac subsidised drugs benefit under the Hospital and Surgical+ base plan covers the costs of Reasonable charges associated with accessing the most effective treatment available, including drugs not subsidised by Pharmac/government, provided they are registered by Medsafe for use in New Zealand, prescribed by a registered medical specialist as appropriate medical treatment, not excluded elsewhere in the Health Plan, and prescribed within Medsafe guidelines. If the drug qualifies for a government or other subsidy, only the remaining cost is reimbursed. All costs under the non-Pharmac drugs benefit are included in the maximum limit of the relevant surgical or non-surgical benefit (up to $500,000 for general surgery or $300,000 for private hospital medical admission). Chemotherapy drugs administered orally at home, prescribed by a registered medical specialist and used during an approved cycle of chemotherapy, are also covered under the private hospital medical admission benefit ($300,000 per person per policy year). A personal accessories benefit of $2,000 per person per policy year is available for items such as wigs, hats, scarves, or mastectomy bras needed during or within 6 months after a cancer procedure or medical treatment.
SmartStay
Wording effective 2026-05-16 · confidence inferred
Unless outlined differently in the policy, prescription drugs must be listed on the Pharmac Schedule (note that section H is only applicable if the drug is used during a procedure in a public or private hospital/facility), Pharmac-approved, medically necessary, and prescribed by a registered medical practitioner. Members must meet Pharmac's funding criteria and the drugs must be funded for the relevant claim. If special authority from Pharmac is required, confirmation from the registered medical practitioner that the member meets the special authority criteria is needed before cover can be assessed. Non-Pharmac drugs are not covered. Chemotherapy drugs administered orally at home that are prescribed by a registered medical specialist and used during an approved cycle of chemotherapy treatment are covered under the private and public hospital medical admission benefit.
StaffCare
Wording effective 2026-05-16 · confidence verified
Non-surgical cancer treatment is covered up to $60,000 per person per policy year for admission to a private hospital or facility. This includes chemotherapy drugs administered orally at home prescribed by a registered medical specialist during an approved cycle of chemotherapy treatment under the policy, as well as other prescription drugs used during non-surgical cancer treatment in hospital. No specific high-cost cancer drug benefit (such as a named drug like Keytruda) or separate oncology drug sub-limit beyond the $60,000 non-surgical cancer treatment benefit is mentioned in the policy wording.
StaffCare+
Wording effective 2026-05-16 · confidence inferred
The non-Pharmac cancer drugs benefit covers the costs of Reasonable charges for Medsafe-registered cancer drugs up to $40,000 for each person in a policy year, regardless of whether the drug qualifies for Pharmac funding or another government subsidy. The drug must be used in the treatment of cancer, prescribed by a registered medical specialist as the appropriate medical treatment, not excluded elsewhere in the Health Plan, and prescribed within Medsafe guidelines. If the drug qualifies for a government or other subsidy, only the remaining cost is reimbursed. All costs under this benefit are included within the maximum limit of the General surgery benefit or the Non-surgical cancer treatment limit ($65,000 per person per policy year, inclusive of non-Pharmac cancer drugs) under the Private hospital medical admission benefit. An excess applies to this benefit.
KiwiCare
Wording effective 2026-04-01 · confidence verified
Under the base Chemotherapy for cancer benefit, up to $8,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer (within the overall $48,000 annual limit). Under Cancer Cover Plus Chemotherapy 100 and Chemotherapy 300 upgrades, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 or $300,000 each claims year respectively. In all cases, 80% of actual charges is covered.
Relevant sublimits (NZD)
- chemotherapy base $48,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
Related exclusions (1)
- Transfusion or injection of autologous blood or blood products, except when used as part of eligible chemotherapy treatment, or where cell saver is used as part of eligible surgical treatment
RegularCare
Wording effective 2026-04-01 · confidence verified
Under the 'Chemotherapy for cancer (base)' benefit, up to $8,000 each claims year is included within the overall $48,000 annual limit for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer. Under the Cancer Cover Plus Chemotherapy 100 upgrade ($100,000 per claims year) and Chemotherapy 300 upgrade ($300,000 per claims year), non-Pharmac-approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, subject to the overall annual cap. No specific Keytruda example is mentioned in the policy text.
Relevant sublimits (NZD)
- chemotherapy base $48,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
Related exclusions (4)
- Healthcare services using technology (such as digital computer images) to help monitor and diagnose skin cancers and other skin lesions – for example, mole mapping
- Transfusion or injection of autologous blood or blood products, except when used as part of eligible chemotherapy treatment, or where cell saver is used as part of eligible surgical treatment
- Drugs that are not Pharmac approved (except as specifically permitted under chemotherapy benefits and the IV infusions non-cancer benefit for Medsafe-indicated drugs)
- Family history of cancer (specific cancer excluded) under Cancer Cover Plus upgrade, where two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55
UltraCare
Wording effective 2026-04-01 · confidence inferred
Under the Chemotherapy for cancer (base) benefit, chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer are covered up to $10,000 each claims year (included within the overall $60,000 annual chemotherapy limit). Under Cancer Cover Plus upgrade options, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 each claims year (Chemotherapy 100) or $300,000 each claims year (Chemotherapy 300). Cancer Cover Plus excludes the specific cancer type for which a covered person has a defined family history of cancer (two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55, where the covered person was aware or should reasonably have been aware before applying); this exclusion does not apply to the base chemotherapy benefit.
Relevant sublimits (NZD)
- chemotherapy base $60,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
Related exclusions (3)
- Healthcare services using technology (such as digital computer images) to help monitor and diagnose skin cancers and other skin lesions, for example, mole mapping
- Transfusion or injection of autologous blood or blood products (except when used as part of eligible chemotherapy treatment, or where cell saver is used as part of eligible surgical treatment)
- Family history of cancer (as defined) excluded under Cancer Cover Plus upgrade only, for the specific cancer type; does not apply to Chemotherapy for cancer (base) benefit
Wellbeing Modules
Wording effective 2026-04-01 · confidence low
Prescriptions cover excludes cover for drugs that are not Pharmac approved
Wellbeing One
Wording effective 2026-04-01 · confidence inferred
Under the Chemotherapy for cancer (base) benefit, up to $10,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed, within the overall $60,000 annual limit. Under the Cancer Cover Plus upgrades (Chemotherapy 100: $100,000 per claims year; Chemotherapy 300: $300,000 per claims year), chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated are covered without a separate sub-limit up to the respective annual cap. The Cancer Cover Plus upgrade excludes cover for the specific cancer where a family history of cancer exclusion applies (two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55, where the insured was or should have been aware of the diagnosis before joining).
Relevant sublimits (NZD)
- chemotherapy base $60,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
Related exclusions (1)
- We don't cover any costs related to healthcare services using technology (such as digital computer images) to help monitor and diagnose skin cancers and other skin lesions – for example, mole mapping.
Wellbeing Two
Wording effective 2026-04-01 · confidence inferred
Under the Chemotherapy for cancer (base) benefit, chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed are covered up to $10,000 each claims year, within the overall $60,000 annual limit. Under Cancer Cover Plus Chemotherapy 100 upgrade, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered within the $100,000 annual limit with no separate sub-limit. Under Cancer Cover Plus Chemotherapy 300 upgrade, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered within the $300,000 annual limit with no separate sub-limit.
Relevant sublimits (NZD)
- chemotherapy base $60,000
- chemotherapy 100 upgrade $100,000
- chemotherapy 300 upgrade $300,000
AIA Private Health
Wording effective 2025-08-05 · confidence no data
No specific rule for this topic on file.
Machine-readable API for this page
GET /api/topic/oncology-high-cost-drugs/summary.md— same content as MarkdownPOST /mcpwith toolget_topic_comparison(oncology-high-cost-drugs)- Per-product:
/api/product/{insurer}/{product}/facts.json
Get a quote covering cancer
Compare NZ health insurers and get a personalised quote for cover relevant to your situation.
Get Quotes