Major medical insurance

This type of insurance is designed to cover everyday health needs, providing Kiwis with additional support for primary healthcare services.

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Understanding Health
Coverage in Aotearoa

When it comes to healthcare in New Zealand, having the right major medical insurance can make a significant difference. This guide aims to provide Kiwis with essential information about comprehensive health coverage options available in the country.

What is Major Medical Health Insurance?

Major medical health insurance offers extensive coverage for serious illnesses, surgeries, and hospital stays. It's designed to complement the public health system by providing faster access to treatment and a wider range of healthcare options.

Key Benefits:

Reduced waiting times for elective procedures

Access to private hospitals and specialists

Coverage for non-Pharmac funded medications

Choice of treatment providers

The New Zealand Health System:
Public vs Private

New Zealand's healthcare system operates on a two-tier model:

Major medical insurance bridges the gap between these systems, offering the best of both worlds.

Public Health System

Funded by taxpayers

Provides free or subsidised care for citizens and residents

May involve longer wait times for non-urgent treatments

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Private Health System

User-pays model

Offers quicker access to specialists and elective surgeries

Provides more options for treatment and care

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Key Factors to Consider When Choosing a Policy

Coverage limits

Ensure the policy provides adequate cover for potential treatments

Pre-existing conditions

Understand how these are handled by different providers

Excess options

Balance premium costs with out-of-pocket expenses

Add-on benefits

Consider additional coverage for GP visits, dental care, or optical needs

Claim Process

Look for providers with straightforward, efficient claim procedures

Understanding Policy Terms

Familiarise yourself with common insurance terminology:

Premium: The amount you pay for your insurance policy

Excess: The portion of a claim you agree to pay before the insurer covers the rest

Waiting period: The time between policy start and when you can make a claim

Exclusions: Conditions or treatments not covered by the policy

The Role of ACC in Health Coverage

The Accident Compensation Corporation (ACC) provides no-fault cover for all injuries in New Zealand. Major medical insurance works alongside ACC, covering health issues not resulting from accidents.

Tax Benefits for Employers

Businesses offering health insurance to employees may be eligible for tax deductions. This can be an attractive option for both employers and staff.

Making a Claim

The claim process typically involves:

Obtaining a referral from your GP

Contacting your insurer for pre-approval

Undergoing treatment

Submitting necessary documentation to your provider

Most insurers now offer online claim submission for added convenience.

Staying Healthy: Preventive Care

Many major medical policies in New Zealand now emphasise preventive care, offering benefits for:

Regular health check-ups

Vaccinations

Screening tests

Taking advantage of these benefits can help maintain good health and potentially reduce future claims.

Reviewing Your Cover

As life circumstances change, so do insurance needs. Regularly review your policy to ensure it still meets your requirements. Consider factors like:

Family status changes

Income fluctuations

Health condition developments

Seeking Professional Advice

While this guide provides a comprehensive overview, individual situations vary. Consider consulting a licensed insurance adviser for personalised recommendations tailored to your specific needs and circumstances.

Major medical health insurance offers valuable protection and peace of mind for New Zealanders. By understanding the options available and carefully considering your needs, you can select a policy that provides optimal coverage for you and your whānau.

Leading Providers in the
New Zealand Market

Southern Cross

Southern Cross is a well-established name in the New Zealand health insurance market. As a not-for-profit organisation, it focuses on returning value to its members.

Offers a range of plans, including basic options like their "Wellbeing Starter" plan

Known for efficient claim processing, with many claims settled within 5-7 working days

Provides a mobile app for easy claims submission and policy management

Offers a network of affiliated healthcare providers for potential cost savings

Regularly scores high in customer satisfaction surveys

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Nib

nib entered the New Zealand market in 2012 when it acquired Tower Medical Insurance. Since then, it has grown to become one of the major players in health insurance.

Offers flexible coverage with their "Basic" plan as an entry-level option

Provides digital tools including a mobile app for policy management and claims

Focuses on preventive care with programmes like health screenings

Offers coverage for some pre-existing conditions after a waiting period

Provides options for adding extras like dental and optical cover to basic plans

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AIA

AIA is a global insurance provider that entered the New Zealand health insurance market by acquiring Sovereign in 2018.

Offers integrated life and health insurance options

Provides a vitality programme that rewards healthy lifestyle choices

Offers loyalty benefits for long-term customers, such as increasing cover over time

Provides options for both individual and business health insurance

Offers a "Private Health" plan as their basic health insurance option

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UniMed

UniMed is another member-owned, not-for-profit health insurer with a history dating back to 1979.

Offers both comprehensive and basic plans, with their "UniCare" plan as a basic option

Provides options for both individuals and employer groups

Known for its strong focus on customer satisfaction

Offers some unique benefits like cover for obstetrics and infertility treatment on certain plans

Provides loyalty benefits, increasing certain benefit limits over time

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