Health insurance in New Zealand is designed to make private healthcare more affordable and accessible, but it doesn’t cover everything. Knowing the common exclusions helps you understand where your policy works best and where you may still rely on the public system or other forms of support.
Why exclusions matter
Health insurance can be a great way to skip public waiting lists and access treatment faster, but every policy has limits. These exclusions aren’t there to trip you up—they exist so insurers can keep cover affordable and sustainable. By being clear about what’s included and what’s not, you’ll know what to expect before you ever need to make a claim.
Common things NZ health insurance doesn’t cover
1. Pre-existing conditions (sometimes)
One of the biggest exclusions is pre-existing conditions—health issues you had before taking out a policy. Depending on the insurer and type of policy, these may be:
- Permanently excluded (never covered), or
- Covered after a stand-down period (e.g. after several years with no further symptoms or treatment).
It’s worth checking your policy wording so you know what applies to you.
2. ACC-related injuries
In New Zealand, the Accident Compensation Corporation (ACC) covers the costs of treatment for injuries caused by accidents, whether it’s a sprain, broken bone, or something more serious. Because ACC already provides this support, private health insurance usually won’t step in for accident-related treatment.
3. Routine GP visits and prescriptions
Most standard health insurance policies in NZ don’t cover the everyday costs of going to the doctor, picking up prescriptions, or getting blood tests. These are considered part of general healthcare, and you’ll usually pay for them directly or through subsidies (like the Community Services Card or Pharmac funding).
4. Fertility and pregnancy care
Maternity care, fertility treatment, and IVF are typically not included in standard health insurance policies. While some insurers may offer optional add-ons, most New Zealanders will rely on the public health system or private clinics for these services.
5. Cosmetic and elective treatments
Procedures that are purely cosmetic or elective - like facelifts, liposuction, or teeth whitening—aren’t covered. Health insurance is designed for medical necessity, not personal choice. However, if a procedure is medically necessary (for example, reconstructive surgery after cancer), it may be included depending on the policy.
6. Experimental or unproven treatments
Policies generally exclude experimental or non-standard treatments that aren’t widely accepted by the medical community. This can include alternative therapies, new medications not yet funded or approved in NZ, or procedures still in trial stages.
7. Overseas treatment (unless specifically included)
Some health insurance policies only cover treatments within New Zealand. If you’re travelling or moving overseas, you may need travel insurance or a specialised international policy for medical care abroad.
8. Preventative care and health checks
Routine screenings, check-ups, or preventive services (like dental hygiene, eye tests, or general wellness checks) are not usually covered. These fall under personal healthcare costs unless you’ve added specific extras.
Optional extras you can add
While the list above outlines common exclusions, many insurers give you the option to add extras for broader cover. Examples can include:
- GP visits and prescriptions
- Dental and optical care
- Day-to-day cover for smaller medical expenses
Adding extras usually increases the premium, but it can help tailor cover to your needs.
How the public system fits in
It’s important to remember that New Zealand has a public health system that provides free or subsidised treatment for many essential services, like hospital stays, emergency care, and maternity. Health insurance is designed to complement—not replace—this system, giving you faster access to specialists, surgery, and treatments that might otherwise involve long waits.
Disclaimer: Please note that the content provided in this article is intended as an overview and as general information only. While care is taken to ensure accuracy and reliability, the information provided is subject to continuous change and may not reflect current development or address your situation. Before making any decisions based on the information provided in this article, please use your discretion and seek independent guidance.
