Health & Medical Insurance

31 FREQUENTLY ASKED QUESTIONS ABOUT HEALTH/MEDICAL INSURANCE

CAN I CHOOSE THE PRIVATE HOSPITAL I ATTEND
Yes, a health insurance policy gives you the control of choosing when and where you would like a medical procedure performed.

CAN I CHOOSE MY SPECIALIST AND/OR SURGEON?
You can choose so long as the charges are reasonable as determined by the insurance company at its sole discretion to be reasonable & within a range of fees charged under similar circumstances by persons of equivalent experience & professional status in the area in which medical treatment is provided.

IF I DEVELOP A PROBLEM WHILE COVERED WILL IT BE EXCLUDED?
No, any health problems that you develop after your health insurance policy is accepted are covered unless it has been specifically excluded from the policy or is a condition that is not covered by your policy.

WHAT HAPPENS IF I MOVE OVERSEAS?
The policies available by almost all insurance companies offer cover only while in New Zealand.

ARE MY CHILDREN COVERED?
Your children can be covered under your policy (as long as they are under aged 21). With some companies an extra on your premium will cover all your children, no matter how many.

WILL MY PREMIUMS INCREASE IN THE FUTURE?
Health Insurance premiums are often reviewed as changes in health costs are ongoing. As you get older the cost of health insurance increases (but with some companies they level out at 65). Premium reviews are normally applied once a year on the anniversary of the policy.

WHAT HAPPENS IF I ALREADY HAVE SOME HEALTH PROBLEMS (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. If the insurer is not able to offer cover for a condition you will be advised & this condition will be specifcally excluded on your policy (this is provided in writing upon completion of an assessment).

I ALREADY HAVE HEALTH INSURANCE, WHAT HAPPENS IF I CHANGE?
We strongly recommend that you do not cancel your existing policy until you are satisfied with a new health insurance policy contract that has been accepted by the insurer. If you have pre-existing conditions which were previously covered under your old policy these conditions may not be covered under the new policy (you will be advised of any exclusions prior to the policy commencing).

DOES COVER TERMINATE AT A CERTAIN AGE?
This depends on the insurer that you select, but most insurance companies’ policies are guaranteed renewable for lifetime and there is no expiry age.

WILL ACC PROVIDE COVER?
ACC will only provide cover if medical costs are attributed to an accident. ACC offers no cover in any other medical event.

IF I NEVER MAKE A CLAIM WILL MY PREMIUMS BE REFUNDED?
No, there is no cash pay back at the termination of a policy.

HOW OFTEN CAN I CLAIM?
When your policy has been accepted you are eligible to make a claim (except for specific benefits where there is a stand down period). There are no limits to the number of claims you are eligible to make, however there are limits to the total monetary amount of claims.

HOW DOES THE EXCESS WORK?
This depends on the insurer that you select. With some companies the policy excess is based on each claim that you make (except for benefits where the excess does not apply). I.e. – if you made two claims of module,000 each & you had selected a 0 excess then the excess would be applied twice & you would be able to claim for a total of module,500). With others the policy excess is based on per person, per policy year (the year is calculated from the start date of the policy). I.e. – if you made two claims of module,000 each & you had selected a 0 excess then the excess would be applied for the first claim but not for the second claim, giving you a total claim amount of module,700).

IS THERE A STAND DOWN PERIOD BEFORE I CAN CLAIM?
There is no stand down on the base plan & specialist – tests features of health insurance policies. There may be a stand down period where there are Dental & Optical add-ons.

WHAT DOES AN EXCLUSION MEAN?
An exclusion means that a particular condition is not covered. If you are excluded for a particular condition you will be advised & it will be specifically referred to in the policy document you are provided with.

DO I HAVE TO PAY FOR THE OPERATION & THEN CLAIM THE MONEY BACK?
It is recommended that you seek pre-approval from the insurer for any medical procedure that you require. This will confirm that the condition is covered & ensure that you do not need to pay for the procedure other than any selected excess amount.

HOW LONG CAN MY CHILDREN STAY ON MY POLICY?
Children are able to stay on your health insurance policy usually until their 21st birthday At this stage they may continue with their own policy irrespective of any health conditions they may have developed.

WHAT HAPPENS IN A MEDICAL EMERGENCY (E.G. CAR ACCIDENT)?
The New Zealand public health care system is designed to provide assistance should a medical emergency occur. It is recommended that you use the services provided should this situation occur. Your private medical insurance may be useful in follow up procedures.

WHAT IF THE TREATMENT I NEED ISN’T CURRENTLY AVAILABLE IN NEW ZEALAND?
If the treatment required is not available in New Zealand the insurers include a provision for overseas treatment which may include travel & accomodation costs. You should refer to the policy descriptions for each insurer for details.

HOW OFTEN DO MY PREMIUMS INCREASE?
Health Insurance premiums are reviewed yearly & increase as you get older,  with some companies each year and others every five years.

ARE MY GP VISITS COVERED?
GP Visits can be covered if you select that add-on option (only available with one or two companies)

ARE MY DENTAL COSTS COVERED?
Dental costs can be covered if you select that add-on option (again only available with one or two companies).

IS PREGNANCY COVERED?
In most cases costs associated with pregnancy are not covered, however some companies cover abnormal pregnancies (excluding caesarian sections).

ARE CONGENITAL DEFECTS COVERED?
Congenital defects are not normally covered.

ARE CT & MRI SCANS COVERED?
CT & MRI Scans are usually covered under the base hospital plan, but otherwise under the Specialists and Tests option.

WHAT DOES PRE-APPROVAL MEAN?
Pre-Approval means obtaining prior approval from an insurer for a medical procedure. It is suggested that you seek pre-approval for any medical procedure so that you can ensure that you will be covered.

ARE NEW BORN CHILDREN AUTOMATICALLY COVERED?
Yes, new born children are usually covered for the first few months, with no health questions asked. After this period they must be specifically added to the policy and may be excluded for pre-existing conditions. After the birth of a new born you should contact us so that we can add this child to your health insurance policy (note this may affect the premium).

ARE COLONOSCOPIES COVERED?
Routine colonoscopies are not usually covered under the base plan however if a colonoscopy is required in order to investigate a medical condition then cover would be available under the Specialists and Tests option.

IF I DON’T OPT FOR THE SPECIALIST & TESTS OPTION, ARE THESE COVERED UNDER THE BASE PLAN?
Specialist & Test procedures are covered under the base plan if they result in hospitalisation (note limits & time periods depend on each insurer and you should refer to the policy information).

AM I COVERED WHEN TRAVELLING OVERSEAS?
No, usually you require travel insurance for this but some companies will cover you for treatment in Australia.  You are however covered for any conditions that you develop while overseas once you arrive back in New Zealand.