Frequently Asked Questions

Health insurance costs vary widely based on your age, coverage level, and provider. Individual plans typically range from $80-300+ per month, while family plans can range from $200-800+ per month. Factors affecting cost include your age, location, health status, and chosen coverage level.

Private health insurance can provide significant benefits including faster access to specialists, choice of surgeon, private hospital rooms, and coverage for services not covered by the public system like dental and optical care. It's particularly valuable for families and those wanting more control over their healthcare.

ACC covers injury-related treatment but doesn't cover illness, routine healthcare, or elective procedures. Health insurance provides comprehensive coverage for illness, routine check-ups, specialist consultations, and elective surgeries that ACC doesn't cover.

The best time to get health insurance is when you're young and healthy, as premiums are lower and you're more likely to be accepted without exclusions. However, it's beneficial at any age, especially if you're experiencing longer public healthcare wait times or have specific health concerns.

Most health insurance policies can start within 1-2 weeks of application approval. However, there may be waiting periods for certain treatments (typically 6-12 months for pre-existing conditions and some procedures).

Hospital cover helps pay for treatment as a private patient in hospital, including surgery, accommodation, and specialist fees. Extras cover helps with everyday healthcare costs like dental, optical, physiotherapy, and other allied health services not covered by the public system.

Coverage varies by policy but typically includes hospital treatment, specialist consultations, diagnostic tests, surgery, and accommodation. Extras cover may include dental, optical, physiotherapy, chiropractic care, and alternative therapies.

Basic health insurance typically doesn't cover routine GP visits. However, some providers offer extras or everyday health cover that includes GP consultations, prescriptions, and other primary care services for an additional premium.

Prescription medications are typically not covered by standard hospital insurance. Some extras policies include pharmaceutical benefits with annual limits ranging from $500-$2,000. Check your policy's Pharmaceutical Schedule for covered medications.

Most policies cover hospital-based mental health treatment including inpatient psychiatric care. Coverage for outpatient counseling and psychology varies by provider - some extras policies include limited sessions per year. Always check specific policy details.

Yes, most comprehensive health insurance policies cover cancer treatment including surgery, chemotherapy, radiation therapy, and specialist consultations. Some policies also cover advanced treatments like immunotherapy and targeted therapies. Check policy limits and exclusions.

Yes, most policies cover elective surgery that is medically necessary. However, purely cosmetic procedures are typically excluded unless there's a medical reason. Waiting periods usually apply, often 12 months for elective procedures.

Dental and optical are usually not included in basic hospital cover. You need to add extras cover which typically includes annual limits for dental check-ups, fillings, glasses, contact lenses, and eye tests. Limits range from $300-$1,500 per year.

Maternity coverage varies significantly between providers. Some include comprehensive maternity benefits, while others exclude it or require significant waiting periods (typically 12 months). Coverage may include antenatal care, delivery, postnatal care, and complications.

Standard health insurance typically doesn't cover overseas treatment. However, many providers offer limited emergency overseas cover (usually up to 90 days) as an add-on. For extended travel, separate travel insurance is recommended.

Yes, you can get health insurance with pre-existing conditions, though coverage and premiums may be affected. Some providers offer coverage with waiting periods or exclusions for pre-existing conditions. It's important to declare all conditions when applying.

A pre-existing condition is any illness, injury, or medical condition that you knew about or should have known about before your policy started. This includes conditions you've seen a doctor for, received treatment for, or had symptoms of, even if undiagnosed.

Waiting periods for pre-existing conditions typically range from 12-36 months, depending on the provider and condition severity. Some providers offer shorter waiting periods with higher premiums or may permanently exclude certain conditions.

Failing to disclose a pre-existing condition is considered non-disclosure and can result in claims being declined, policy cancellation, or even being charged with insurance fraud. Always provide complete and honest information during the application process.

Some insurers may review exclusions after a certain period (typically 3-5 years) if you can demonstrate the condition is well-managed or resolved. This usually requires medical evidence and approval from underwriters. Not all providers offer this option.

Premiums typically increase annually due to factors including rising healthcare costs, increased utilization, medical inflation, advancement in treatment technologies, and your increasing age. Most providers apply rate increases of 5-8% per year on average.

You can reduce costs by increasing your excess, choosing lower benefit limits, removing extras cover if not needed, opting for shared hospital accommodation, joining a group scheme if available, and paying annually instead of monthly. Compare providers regularly.

An excess is the amount you pay towards each claim before insurance covers the rest. Common excess options range from $0 to $500 per claim. Higher excess reduces your premium but means you pay more when making claims. Choose based on your claim frequency expectations.

Many providers offer discounts for paying annually (typically 5-10%), family policies, healthy lifestyle programs, no-claims bonuses, group schemes through employers, and loyalty discounts for long-term customers. Ask providers about available discounts.

Generally, health insurance premiums are not tax deductible for individuals in New Zealand. However, self-employed people may be able to claim a portion as a business expense if used for business purposes. Consult a tax advisor for your specific situation.

Most providers offer online claim submission, mobile apps, or phone claims. You'll typically need to provide invoices, receipts, and relevant medical documentation. Many providers also offer direct billing with participating healthcare providers.

Simple claims are usually processed within 5-10 business days. Complex claims requiring additional information may take 2-4 weeks. Many providers offer fast-track processing for urgent cases and direct billing eliminates waiting for reimbursement.

Direct billing allows your healthcare provider to bill your insurance company directly, so you don't have to pay upfront and wait for reimbursement. Not all providers and specialists offer this service. You may still need to pay the excess and any non-covered amounts.

Claims can be declined if treatment isn't covered by your policy, waiting periods haven't been met, you haven't disclosed relevant information, treatment isn't medically necessary, or policy limits have been reached. Always check coverage before proceeding with treatment.

If your claim is declined, request a detailed explanation. You can appeal the decision by providing additional medical evidence. If still unsatisfied, you can escalate to the provider's internal disputes process, then to Insurance & Financial Services Ombudsman if needed.

Most insurers require pre-approval for hospital treatment and major procedures. This ensures the treatment is covered and helps you understand costs in advance. Emergency treatment is usually covered without pre-approval. Always check your policy requirements.

The main providers are Southern Cross (largest market share), nib, Accuro, AIA, Cigna, Fidelity Life, and UniMed. Each offers different policy options, pricing, and benefits. Southern Cross is the most established, while others may offer competitive pricing for specific demographics.

Southern Cross is New Zealand's largest health insurer with the widest provider network and most comprehensive coverage options. However, 'best' depends on your individual needs, age, budget, and coverage requirements. nib, Accuro, and AIA may offer better value for specific situations.

Southern Cross typically offers more comprehensive coverage with wider hospital network access but at higher premiums. nib often has more competitive pricing, especially for younger people, with innovative features like health rewards programs. Both offer quality coverage - compare based on your needs.

Consider switching if you find better value, improved coverage, or lower premiums elsewhere. However, factor in potential waiting periods for new policies, loss of continuity benefits, and re-underwriting with current health conditions. Generally review every 2-3 years.

Compare premium costs, excess amounts, annual benefit limits, coverage for specific treatments you need, specialist and hospital networks, waiting periods, claim process ease, customer service reputation, and any exclusions. Don't just choose based on price - ensure coverage meets your needs.

Yes, you can usually upgrade your policy at any time, though waiting periods may apply for new benefits. Downgrading coverage may only be possible at renewal. You can also switch providers, but consider waiting periods and loss of continuity benefits.

Most insurers offer a grace period (typically 30 days) to catch up on missed payments. If payment isn't received, your policy may be suspended or cancelled. While suspended, you have no coverage but may be able to reinstate. Check your policy terms for specific procedures.

Yes, you can usually cancel your policy at any time by providing written notice (typically 30 days). However, you won't receive a refund for the current coverage period if paying monthly. If you've paid annually, you may receive a pro-rata refund minus any claims made.

Continuity benefits reward long-term customers by reducing or waiving waiting periods when upgrading coverage or switching to a similar policy. Some providers recognize continuous coverage from other insurers. This benefit can be valuable when changing policies or providers.

Most providers don't allow you to pause coverage. If you're traveling overseas, some insurers offer reduced premium options for extended absences. If you cancel and restart later, you'll be underwritten again based on current health and may face new waiting periods and exclusions.

Family policies typically cover 2 adults and dependent children (usually up to age 21 or 25 if studying) under one policy. Premium is often cheaper than separate policies. Each family member may have different coverage levels, and all share annual benefit limits unless specified otherwise.

Children are usually covered under family policies until age 18-21, or up to 25 if in full-time study. After this, they need their own policy. Getting individual coverage while young and healthy is advantageous as premiums are lower and acceptance is more likely.

If you have maternity cover, most pregnancy complications are covered including emergency caesareans, gestational diabetes management, and neonatal intensive care. However, waiting periods typically apply (12 months common). Pre-existing fertility issues may be excluded.

Health insurance becomes more valuable with age as health issues increase and public wait times lengthen. However, premiums also increase significantly. Seniors should weigh premiums against likely healthcare needs. Some providers offer senior-specific policies with adjusted benefits.

Yes, but you need to maintain New Zealand residency. If you're overseas for extended periods, inform your insurer as most policies only cover NZ treatment. Some providers offer limited overseas emergency cover. For extended overseas work, consider international health insurance.

Most NZ health insurance policies only cover treatment in New Zealand, so they're not useful if you move overseas permanently. You should cancel your policy and arrange international health insurance in your new country. Some providers may offer coverage if you return regularly.

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