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Health Insurance

Health Insurance FAQs

What is Health insurance?

Private Health insurance allows you to bypass the NZ public waiting list in the event that you need to have a major scan, treatment or surgery.

Can I choose any private hospital or Specialist that I'd like?

Usually yes, but it does depend on the health insurer. Southern Cross will only cover some procedures if they are performed by one of their affiliated providers. However other insurers usually allow you to choose (and often your GP or Specialist will have a particular recommendation for you).

How does the excess work?

The "excess" is the portion of the medical bill that you pay (e.g. if your claim is $5,000 and your excess is $250, you'd pay $250 and the insurer pays the rest).

Health insurers apply the excess in slightly different ways. For more, please view the comparison table.

Can I cover my children?

Yes, you can. The maximum "entry age" for children varies by insurer. If your child is over the age of 16 then they will need to fill out their own application form - but you can pay their premiums if you like!

Do I have to pay for the operation or treatment first & then claim the money back?

It's best to ask the insurer for "prior-approval" before the treatment or surgery happens, which means that the insurer will pay the health provider directly once it's done. This keeps things simple, and means you don't need pay anything more than your excess.

What happens if I already have some health problems (pre-existing conditions)?

Usually, health insurers don't cover pre-existing conditions. When you apply for your health insurance policy you will be asked to provide information on your medical history. The insurer will then make an assessment on whether they are able to cover any existing medical conditions - and if not, the insurer will notify you in writing before your policy starts.

I already have health insurance - can I change insurers?

It's very important to keep your current plan going until the new one has been set up. If you have pre-existing conditions which were covered under your old policy these conditions may not be covered under the new policy. So it's vital to keep your current cover going until you're totally happy with what the new insurer will offer.

What happens if I need to claim?

LifeDirect is here to help. If you think a claim might be needed, please contact us straight away. We will then contact your insurer and get the claims process underway.

Is there a stand-down period before I can claim?

With most insurers there is no stand-down period, however do check the insurers policy document for more information. Some insurers also have a stand-down period on their optional "GP Benefit" and "Dental & Optical" Benefit.

What happens in an emergency situation (like a car crash)?

In an emergency you'd be taken straight to a public hospital - your health insurance doesn't cover these costs (as this is provided for free). However following emergency treatment and stabilization, there might be follow up treatment needed - which is where waiting lists start and health insurance might be needed.

What is an "exclusion"?

An exclusion is something not covered by the policy. Some exclusions are built into the policy - for example health insurance tends not to cover cosmetic surgery. Also, usually pre-existing health issues are "excluded" from the policy. This means that the insurer won't pay for investigations or treatment relating to that issue.

Will my premiums increase in the future?

Health insurance premiums are affected by age and also by changes in the cost of health care (as new and more advanced treatments become available, health costs usually increase). The increase varies, however we recommend that you're prepared for an annual increase of around to 10-15%.

What are my payment options?

The most common payment options are Direct Debit or Credit/Debit Card, and these are the two options available through our website. However, with some insurers there are other methods available (e.g. annual cheque), so please let us know when you apply if you'd like to choose a different option.

When will I make my first premium payment?

Not until after your application has been assessed and accepted. If you choose to pay monthly (by Direct Debit or Credit/Debit Card) then you can usually select the day of the month that you'd like you premiums to come out.

What happens if I stop paying my premiums?

If you stop paying premiums, after a period of time (usually three months) your cover will end. If you ever need to change your payment details (e.g. you change bank accounts) just contact us and we'll get it sorted.

Does smoking affect my premium?

Yes, all of the insurers we use offer lower premiums to non-smokers. To an insurer a person is usually classed as "non-smoker" once they have been totally smoke-free for 12 months.

Will ACC provide cover?

ACC will only provide cover if medical costs are as a result of an accident (they don't cover sickness for example). Also in some cases ACC will only partly pay for a procedure. In this case you could usually make a claim to your insurer to "top up" the difference.

Are GP visits covered?

Usually not. You can choose to add GP cover onto your policy with Accuro, Southern Cross, and nib if you like. This add-on benefit tends to be quite expensive so generally you would only consider adding this cover if you visited the GP frequently throughout the year.

Are dental costs covered?

All plans cover oral surgery (like the removal of impacted wisdom teeth), however day-to-day dental costs (like a filling) are not covered. You can choose to add extra dental cover with Accuro, Southern Cross, and nib, however as mentioned above, you might only get your moneys worth if you visited the dentist a number of times throughout the year.

Is pregnancy covered?

Some plans offer limited cover for pregnancy complications, however usually costs related to pregnancy are not covered by health insurance. Fertility treatment is not covered.

If I don't add on cover for Specialists & Tests, are these covered under the base policy?

These costs are only covered before and after hospital treatment (usually 6 months before and after hospitalization - though this does vary depending on the insurer). However, if hospital treatment is not needed, these are not usually covered unless you choose to have the Specialists and Tests add-on. For example, if you have a Specialist visit and then surgery, if your surgery claim is approved then this will also retrospectively cover the initial Specialist consultation.

What happens if I move overseas?

Policies usually only cover treatment in NZ (though Cigna and Partners do offer good cover in both NZ and Australia). If you permanently emigrate (and will never return to NZ) you would usually cancel the health insurance, but if there is any chance of returning it's usually best to keep your insurance - if a significant health issue emerges while overseas you can return to NZ for treatment.

Am I covered while travelling overseas?

(We don't offer Cigna Health Insurance) Cigna and Partners offer some cover in Australia, however health insurance is not designed to cover costs that are incurred overseas (you'd need travel insurance for this). However if a health issue emerges while you're overseas, you are covered for treatment for this when you return to NZ.

What information do I receive?

Once your policy has been set up the insurer will send you your official policy document. You will also receive access to MyLifeDirect where you can view your policy information online anytime .

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