Not all health insurance is created equal, and what you're covered for will depend on your policy. You may be covered for:
You can opt for full cover with all the bells and whistles or a simplified option to cover you for major health events. Either way, there is an option available that will suit you. Let your adviser lead the way here.
Image from the AIA website.
Adding on specialists and tests will cover you for specialist appointments, health screening, tests and diagnostic imaging – whether or not you require surgery.
It costs approximately 25% more for specialists and tests, but it's a valuable cover to have if you become unwell. Keep in mind that certain health conditions may not require surgery but may require ongoing consultation and treatment via a specialist.
An excess is the amount that you contribute to a claim. You get to choose your excess at the time of application, and if you choose a higher excess, you will receive a discount on your premiums. When we choose your excess, we factor in your:
Having a higher excess will indeed make your premiums cheaper, but it could mean you may not be able to claim for lower-cost procedures and treatment.
For instance, I had a client recently who needed a colposcopy (cost approx. $1,500 - $2,000), but they have a $2000 excess, so they will have to pay for the procedure out of pocket or wait to have the treatment publicly. We keep this in mind when we set up your policy.
Finding the right balance for you is important: would you prefer to pay a lower premium and contribute more if you need to claim – or pay a higher premium but have a no or low excess to claim?
Graphic from the NIB website.
PHARMAC is the New Zealand government agency that decides which medicines are funded in New Zealand. Non-PHARMAC drugs and pharmaceuticals are not covered and can be very expensive – sometimes to the tune of hundreds of thousands of dollars per year for a course of treatment.
What you need to know:
You only have to look on GoFundMe or read the frequent media articles and appeals to see how many people are looking for funding for non-PHARMAC cancer treatment drugs in New Zealand. It’s incredibly sad to see, and it’s the reason I always speak to my clients about non-PHARMAC cover.
If full health insurance doesn’t feel like the right fit for you (or your budget), you now have the option of cancer only cover, which provides private care for cancer treatment. It covers non-PHARMAC cancer drugs, too.
Cancer only cover is around 30% of the cost of full health insurance. It’s an excellent option for older clients where premiums are too expensive and for younger clients who are hesitant to take out full health insurance.
On average, Kids Cover costs about $5 a week, so it’s not a huge investment.
While the public system is pretty good for kids, going private allows you to choose your surgeon, where the procedure is performed, and when you have the treatment. You can skip the waitlist and enjoy the comforts of private care. For instance, if your child needs their tonsils out, you won’t be waiting months and dealing with tonsillitis until you can get in for surgery.
Common claims for kids include:
Your adviser should know your policy inside and out to help you maximise your benefits if you make a claim.
Some additional benefits include (depending on the policy):
One of my clients had heart surgery in Wellington at a private hospital, and he and his partner travelled down together the day before. She stayed nearby in a hotel so she could support him through surgery. The policy covered their accommodation and travel costs.
Unless your adviser is on to it, these additional benefits are easily overlooked and missed during the claims process.
A pre-existing condition is a medical illness, injury, or symptom that you already have – or have sought treatment for – before applying for health insurance. The insurer may choose to exclude this condition from your cover.
Most people have at least one. We do our part by reviewing your exclusions with your insurer regularly.
Say you had a sore knee last year that required an x-ray but didn’t need any further treatment; it is likely to be automatically excluded. In two years, if you’ve had no additional problems with the knee, we can review the exclusion and get it removed. If your adviser isn’t reviewing your exclusions regularly, you could be missing out on valuable protection.
There are other options, too. For instance, NIB has a policy that covers most pre-existing conditions after three years.
Health insurance is the most strictly underwritten insurance because of the ease with which you can claim. Remember that exclusions are not necessarily permanent – they can be reviewed, and we are proactive with this process.
Got a health insurance question? Let us know!
While we’re home loan and insurance experts, our blog posts are for general information purposes only and are not intended as financial advice. If at any stage you need personalised advice, get in touch on 0800 346 765, or email finsol@finsol.co.nz.