Hospital Or Surgical Cover
Built for larger private treatment costs. It may include surgery, hospital charges, specialist care and major diagnostic testing. Some plans also cover non surgical hospital treatment.
What it covers
What Health Insurance Can Cover
Health Insurance usually pays or reimburses eligible private treatment costs, subject to the policy terms. The benefits depend on the plan selected and may include:
- Surgery and treatment in an approved private hospital
- Specialist consultations and surgeon appointments
- Diagnostic imaging and tests such as MRI, CT and endoscopy procedures
- Cancer surgery, chemotherapy, radiotherapy and specified medicines
- Post operative treatment, physiotherapy or home nursing connected with an eligible procedure
- GP visits, dental care, optical care and physiotherapy under an everyday benefit
A plan may cover one area well and provide little for another. We compare the benefit wording, limits, referral requirements and provider rules before you apply.
Two kinds of cover
Hospital Cover And Everyday Cover Serve Different Needs
Many people place hospital and specialist cover first because a major procedure could exceed their normal budget. Others add everyday cover because they expect to claim regularly. We compare the likely benefit with the extra premium.
Everyday Cover
Contributes towards regular healthcare such as GP visits, dental care, glasses and physiotherapy. These benefits commonly have annual limits and may repay only a percentage of each bill.
Before surgery
Check Specialist And Diagnostic Cover Before Surgery Is Needed
The work that identifies a medical problem often happens before anyone recommends surgery. You may need a specialist consultation, an MRI, a CT scan, an ultrasound, an endoscopy or laboratory tests.
Some policies cover eligible specialist appointments and major diagnostics even when surgery does not follow. Other plans restrict these benefits, require a specific referral or connect them to an approved procedure.
We check if standalone investigations are covered, which providers you can use, the annual limits and any prior approval requirement.
Ask for prior approval before an expensive test or procedure. Give the insurer the referral, clinical details and written estimate it requests, then confirm any later change to the treatment or cost.
Cancer cover
Cancer Treatment And Medicines Not Funded By Pharmac
Cancer benefits vary considerably between Health Insurance policies. Cover may include diagnostic tests, specialist consultations, surgery, chemotherapy, radiotherapy and medicines, but each benefit can have its own criteria and limit.
Some policies include eligible cancer medicines that are not funded by Pharmac. Others offer this as an additional benefit or apply a separate annual or lifetime limit. The policy may also specify that the medicine must be Medsafe approved for the condition being treated.
We compare the treatment limit, drug limit, administration costs and related diagnostic benefits. The word cancer alone does not tell you how much a policy would pay.
The cost
How Excesses, Limits And Premiums Work
An excess is the amount you pay towards an eligible claim before the insurer contributes. A higher excess will usually reduce the premium, but you must be able to pay it when treatment is required.
The excess may apply per claim, per policy year or on another basis. Benefits can also have annual or lifetime limits, percentage repayments and approved provider pricing.
Premiums can change as you age and when the insurer reviews its rates. We consider which benefits you would keep if the cost became harder to manage.
Pre-existing conditions
Health Conditions You Had Before Applying
Having an existing condition does not automatically stop you getting Health Insurance. The outcome depends on the condition, the insurer and the product.
A condition can be treated as pre existing without a formal diagnosis. Previous symptoms, investigations, treatment or medical advice may be relevant. The insurer may exclude it, cover it after a waiting period, offer modified terms or decline that risk.
Answer the application questions fully and accurately. Nik will help organise the information and explain exclusions before you accept. Keep existing cover until a replacement policy has been accepted and reviewed.
The wider plan
Health Insurance And Your Wider Financial Plan
Health Insurance helps with eligible treatment costs. It does not replace the income your household may need while you are unwell.
Trauma and TPD Cover can provide a lump sum after a qualifying serious condition or permanent disability. Income Protection insurance can provide a monthly benefit when illness or injury stops you working and the policy definition is met.
Mortgage Protection focuses on a monthly benefit connected with your home loan or another basis stated in the policy. Life Cover can provide a lump sum after death or a qualifying terminal illness.
Your mortgage, insurance and investments are all part of your financial plan. While Sarah helps you secure the right mortgage, Nik helps protect the life built around it and plan for what comes next.
How we work
How Does Nik Work Through Your Insurance Advice?
Insurance advice should start with your needs, goals, responsibilities, and financial position, not with a product.
Nik works through what matters most, what could create serious financial pressure, and what options may help manage those risks.
Understand Your Situation
We look at:
Clarify What Matters Most
We talk through what you would want protected if something went wrong. This may include:
Identify The Main Risks
We look at the events that could create the biggest financial impact. This may include:
Consider The Options
Before looking at insurance, we consider what else may already be available. This may include:
Insurance is only one part of the discussion.
Compare And Structure The Cover
If insurance is appropriate, we compare available options and explain how they work. This may include:
The focus is matching the structure to your needs, goals, and budget.
Apply, Review And Support At Claim Time
If you decide to apply, Nik helps prepare the application and supporting information. Nothing is submitted to an insurer without your approval.
Once cover is in place, it should be reviewed when life changes. If you need to claim, Nik can help you understand the claim process and what information may be required. The insurer still assesses the claim under the policy wording.
Is Private Health Insurance Worth It In New Zealand?
It can be if you value eligible private treatment and the premium fits your budget. Compare the cost with your ability to pay privately, use savings or wait for planned public treatment. Exclusions, excesses and limits matter as much as the monthly premium.
Does Health Insurance Cover Pre Existing Conditions?
Sometimes. An insurer may cover the condition, exclude it, apply a waiting period or decline that risk. Earlier signs or symptoms can count even without a diagnosis, so answer every health question fully.
Are GP, Dental And Physiotherapy Costs Covered?
Only when the policy includes the relevant everyday or outpatient benefit. These benefits usually have annual limits and may refund only part of each charge. Hospital cover on its own should not be assumed to include routine appointments.
Will Health Insurance Cover Medicines Not Funded By Pharmac?
Some policies cover specified medicines that Pharmac does not fund, particularly for cancer treatment. Check the annual or lifetime maximum, eligible conditions, Medsafe requirements and administration costs.
Can I Choose My Specialist And Private Hospital?
Often, but the choice is subject to the policy. The specialist, facility or treatment may need to be approved, recognised or part of the insurer's provider network. Check the referral and prior approval requirements before booking.
Does Health Insurance Cover Treatment After An Accident?
ACC is usually the first place to claim for an accidental injury. Health Insurance may contribute only as allowed by the policy, such as when ACC does not pay the full eligible cost. Ask both providers which approval is required.
Should I Cancel My Existing Policy Before Switching?
No. Apply for the replacement first and review its exclusions, waiting periods, excesses and limits. A condition covered under the old policy may be excluded under the new one.
Next step
Talk To Nik About Health Insurance
Bring your policy schedule, details of employer cover, medical history and the benefits you want reviewed. Nik will compare the terms and explain the trade offs between hospital, specialist, cancer and everyday cover.
Your first conversation with Nik is free. Before providing personalised advice, he will explain the scope, any fee, how he is paid and any payment The Mortgage Advisers may receive if you act on his recommendation. You can decide whether to continue after receiving those details.