Frequently asked questions

And important information about your options

Top 5 questions

1. What are the different types of medical insurance plan ?

Medical Insurance plans in New Zealand are offered in 5 types:

HOSPITAL & SURGICAL COVER

(or Base plans) cover all of the most expensive areas of healthcare, and typically offer cover for all major hospital or surgical procedures, major diagnostic tests such as MRI & CT scans, as well as any other diagnostic tests or specialist visits that are connected with that particular medical condition (‘connected’ usually means the 3-6 months before or following surgery)

Additional Benefits such as post-surgery home nursing cover, public hospital cash grant, support person accommodation benefit and Funeral Costs benefit are also included as standard.

These types of plan typically have high claim amounts (usually over $200,000 per year) so will cover any current medical treatment or procedure.

THE ADDITIONAL SPECIALISTS & TESTS PLAN

– (also called Base Plan + Specialists) - extends the Base Plan to include all minor diagnostic tests or specialist visits; even if they are not related to a hospital or surgical procedure, or fall outside of the 3 month connected period.

THE GP & PRESCRIPTION PLAN

extends cover to include GP visits; to a maximum of $55 per visit, or $300 per year, and prescription costs to a maximum of $300 per year.

THE OPTICAL & DENTAL

- extends cover to include Optical benefits; usually $300 per year for glasses, and $300 per year for optician costs, and dental costs; usually to a maximum of $500 per year.

THE COMPREHENSIVE PLAN

combines the base plan, Additional specialists & tests, GP & Prescription and Optical Cover to provide a full service plan.

2. Which type of health cover should I have ?

Our advice: take the cheaper type - with an excess.

The main reasons for having health or medical insurance cover are to protect yourself against the financial risks of having to pay for your own treatment, and to obtain the best possible treatment with the minimum of delay and stress - both of these are covered by having the cheaper Hospital & Surgical cover.

There's no real point in paying extra to protect yourself against GP bills or optical & dental costs - in the long term your premium savings will almost certainly outweigh what you pay for these smaller, more predictable costs; and it will free up money to be used for other, more important types of protection such as critical illness cover, mortgage protection or life assurance.

As for the extended Hospital & Surgical plan; which includes any specialist visits or minor diagnostic tests even if they are not related to surgery - the extra premium for this, depending on your age, is usually $20-$40 per month - you'd therefore need to make at least one claim a year under this extra benefit in order for it to pay - again this is gain unlikely; especially if you have an excess.

The one exception to the extended plan is for children, as the premium difference is fairly small; about $5-6 per month. It can therefore be useful to have the extra cover as it provides more peace of mind for a small cost; there are however only certain insurers that will allow you to mix plans & excess amounts between family members - please mark this as important if you'd like your report to take this into account

3. Who has the best health insurance policy ?

It depends..

There are many factors which need to be taken into account when choosing your provider - every company is slightly different in the way that it structures it's cover, and every individual, couple or family group is different in terms personal situation and age profile..

Some companies for example have the same premiums for smokers and non-smokers, some base their premiums on the age of the youngest adult, some have 'per-child' premiums whilst others have a flat rate no matter how many children you have - if any one or more of these, or the many other structure variations or differences applied to you, it would make a significant difference in what you pay.

4. What are the important differences between insurers ?

There are 2 areas in which some companies have a significant advantage over others:

1. Cover for non-Pharmac medications

Drugs & medications prescribed by GP’s & Specialists in New Zealand are all approved by Medsafe - not all of these drugs are offered and subsidized by Pharmac however; and the majority of insurance companies will only cover drugs on the Pharmac list.

A specialist wanting to prescribe a drug not covered by Pharmac is now a common rather than infrequent occurrence – for many this has resulted  in patients (even those with ‘standard’ medical insurance) having to make the difficult choice of either paying a very large sum themselves (sometimes in excess of $100,000) or to take an alternate, less effective medication; clearly neither of these situations are ideal, and really defeat the whole point of having medical cover in the first place.

We would therefore strongly recommend that the option to have non-Pharmac cover included in your benefits to be highly important – you can enter this as a priority on your Report request form if you feel the same.

Further information links:

New Zealand Herald article 1  New Zealand Herald article 2  New Zealand Herald article 3

2. Non-changeable policy conditions

This option is exactly what it says; the insurer guarantees that the conditions and terms under which you took out your plan cannot be changed to your detriment.

This gives you far more peace of mind that an insurer cannot change the conditions of your cover if certain medical treatments or procedures become too expensive for them.

5. Why should I use Medical Direct ?

1. Because we're good at what we do – we’re one of the only brokers in New Zealand specialising in Medical Insurance.

2. Because we’re free to recommend any company which we feel best suits your needs – we don’t have any agreements with particular insurers which makes us biased in our advice.

3. Because we’ve designed our service to provide you with advice, information & administrative support in a way that suits you – if you want to meet with an adviser to discuss things personally then that can be arranged – if you’re happy with email correspondence, post, and the odd phone call, we can do that too.

4. And because you don't pay extra for using us; the premiums we quote you will be exactly the same as if you went direct to the insurer, and in return you get somebody to help you throughout the life of your policy – both for yearly admin and in the event that you have a claim.

5. We can advise you on any other insurances that you may need, so that you have one company looking after you.

Next step - Request a personal quotation & advice report

More questions....

Should I choose an excess ?

Yes.

We all hope that medical insurance, like all insurances, will be a waste of money - adding an excess to your policy allows you to waste a little less.


Most companies offer a discount of up to 20% for adding an excess of $250-$300. Paying the first $250, $500 or $1,000 of each claim won't increase your risk by a great deal, but it will make a big difference in the total premiums over the course of 10 or 20 years.


There is also the option to increase your excess in later years in order to keep premiums affordable; a 30% discount may not amount to very much when you're paying premiums as a 30 year old; but it can be a great deal when you're in your 60's..

Do I really need insurance ?

Yes...

Although we're all hopeful that it won't happen to us, you will, statistically, at some point in your life require hospitalization or surgery - in many cases two, three or four times.

The state health service still provides excellent cover for accident and emergency treatment, but the situation regarding elective surgery is getting worse each year.

Whatever your viewpoint as to whether medical treatment should be taken care of by government, the only way to ensure that you and your family will receive prompt and proper treatment is through taking out heath & medical insurance, and even though the premiums may at times seem high, the possible alternative of having to pay tens of thousands of dollars out of your own pocket, with the resulting effect on your whole financial position, would seem to make this a low price to pay.

Are there alternatives to medical cover ?

No, not really.

Although it may be tempting to think that you could save the money that you would normally pay into an medical insurance policy into your own account for possible future use, the levels of medical inflation, (currently about 10% a year) would mean that an investment would need to grow at an unrealistic rate just to keep up.

At present heart surgery can cost up to $100,000, and cancer therapy up to $150,000. These figures could double every 10 years, meaning that any investment account would fall drastically short of providing the right funds.

Obviously there is the chance that you could go through your whole life without ever making a claim (which would be a good thing) but there's also the possibility that you could have several significant claims - in this scenario the amount paid in premiums would become insignificant.

If keeping your premiums to a minimum is your priority then our advice would be to take out a basic policy with a large excess - this way you'd be paying the minimal amount, but still passing most of the financial risk to the insurance company, rather than keeping it yourself.

How much will premiums increase ?

Again this will depend on the choice of company. Some have age-related premiums increasing each year, whereas others calculate premiums on 5 year age bands.

Regardless of how often these age-related increases are applied, you can expect to receive an increase every year or so to reflect higher than expected claims (company wide rather than specific to you) or to reflect the rise in medical costs.

Will I need a medical examination ?

Unlikely.

Most companies try to issue policies based on the information provided by you an the application form.

In some cases they will write to your GP for further information. If they do require a medical, this is usually paid for by the insurer, and performed by either your GP or a home visit nurse.

What if I have pre-existing medical conditions ?

A pre-existing condition is a health problem which exists (with your knowledge) at the time of applying for cover.

This could be viewed in any number of ways;

1. It may be accepted by the insurer company immediately.

2. It may be accepted after a certain period.

3. It may be excluded from your cover for life.

4. An additional premium may apply.

How a company will consider a pre-existing medical condition will only be fully known once your application has been processed; we can however provide some guidance as to the likely outcome for a given condition - be sure to enter a brief summary of any previous or ongoing medical conditions in your quotation & report request

(Please note that any special terms that an insurer wishes to place on your policy will be clearly stated and agreed by you before your cover commences)

Will my insurance cover me overseas ?

Some companies will provide cover for people residing in Australia, but limit cover to levels equivalent to New Zealand treatment costs.

This could be an advantage to anybody considering working in Australia, with the intention of one day returning to New Zealand, as the policy would be continuous, rather than being reassessed based on your new and possibly diminished health status.

Some insurers are also now offering a medical tourism option, which allows you to have your treatment provided overseas.

As for medical insurance vs. travel insurance: having medical insurance cover in New Zealand will not cover you for emergency or non-emergency treatment elsewhere in the world, therefore its important to make sure that you have travel insurance arranged.

How do I add children to my health cover ?

Adding new-born children to your medical policy is simple. If you do this within three months then most insurers require only a letter from the existing policyholders/parents. After 3 months they may require a short application

Children are normally covered until the policy anniversary following their 18th birthday, though some insurers will cover children to age 21 or 25.

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

No.

Standard medical polices are accepted from the day that you and your insurer issue your cover. Obviously if you have a claim for a major condition after 3 days they'll want to talk to your GP to make sure that it wasn't something you knew about before you completed your application, but if this isn't the case then claims will be paid in full.

The only exception to the stand-down rule applies to the GP & Prescription and Optical & Dental benefit options; these have waiting times of up to 6 months (depending on the company) before you can claim under this option (another reason that we don't recommend them !)

Do I need to remember every detail of my medical history ?

No.
The important thing when completing any application for insurance is to disclose at least basic details of any past medical treatment or consultations. If the insurer then needs more detail in order to assess your application they can always contact your GP.

Do I need to be a NZ resident ?

Most companies will only offer cover to those people normally resident in New Zealand. Cover can be obtained for new immigrants on work-to-residency, temporary or student visas, though the insurer may include some additional conditions, such as a higher excess amount or annual premium payment.

There is an excellent plan offered by Accuro for non-residents or short term visa holders; please click here for details

How do I make a claim ?

There are two ways that you can reclaim costs associated with medical treatment;

If its just a simple consultation or one-off test then you can pay the bill yourself, and then send in your receipt and a claim form to your insurers.

If the treatment is likely to spread over a longer period, or involve multiple claims or significant costs, then you can apply for pre-approval. This will mean that the insurer will pay the costs direct to the treatment provider, as well as confirming that you will be fully covered for all costs.

How much can I claim ?

There is no limit on the amount of claims that you can make, as long as they stay within the policy limits for each area. The limits for most companies are s very high however; so this should not be an issue.

Where do I go for treatment ?

Obviously policyholders with Southern Cross have the bulk of their treatment carried out in a Southern Cross hospital or with a Southern Cross linked specialist.

Policyholders with the other, non-hospital linked providers have even more freedom, in that they can get their surgery, test or specialist consultation carried out wherever they wish.

In reality most of the decisions of this type will be made by the specialist that you are first referred to, as they will have their own private practice and/or preferred treatment location.

What are the advantages & disadvantages of changing insurers ?

There are numerous ways that you could benefit from reviewing and switching your cover to an alternate provider.

1. You may be able to gain more benefits for the same premium.

2. You may be able to gain the same benefits for less money.

3. The new insurer may have a more favorable policy structure for your age & family profile, resulting in long term premium savings.

The only potential disadvantage comes from the fact that you may not receive equal underwriting terms. A new insurer will re-assess your medical history at the time of the new application, which may be very different than the time of your original one. Although there's nothing to stop you applying for new cover to see what sort of terms you would be offered, its very important that you do not cancel your existing insurance until you have all of the new terms available so that you can make a comparison.

If you have an existing medical policy that you'd like to review, then we would recommend you completing the recommendation report request which will provide us with the information we require to give you a summary of potential advantages & disadvantages.

Next step - Request a personal quotation & advice report