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Health Insurance basics

Health Insurance FAQs

  • 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 (Accuro is 25, OnePath is 18, Southern Cross is 20, Sovereign is 20, and nib is 20).

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

    It's best to ask the insurer for "prior-approval", which means that the insurer will pay the health provider directly. 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 but would like to change.

    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.

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

    With most insurers there is no stand-down, however Southern Cross will not pay a claim for the first 3 months of the policy, and Sovereign and nib have a stand-down period of 12 months for the extraction of wisdom teeth. 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 is 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 does not 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 up to 10-15%.

  • 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.

  • If I never make a claim will my premiums be refunded?

    No, health insurers don't offer a premium refund if no claims are made.

  • 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 add GP over with Accuro, Southern Cross, and nib, however we usually recommend that you stick with Hospital Cover (and additional Specialists and Tests if you'd like extra cover).

  • 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 add extra dental cover with Accuro, Southern Cross, and nib, however like the GP cover mentioned above, this is not an add-on that LifeDirect usually recommends.

  • 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 opt for the Specialists & Tests add-on, are these covered under the base policy?

    These costs are 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.

  • What happens if I move overseas?

    Policies usually only cover treatment in NZ (though OnePath 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?

    OnePath 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.

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