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What is Health Insurance

What is it?

Taking out Health Insurance means you can access treatment when you need it; therefore giving you peace of mind you won’t be stuck on a waiting list.

Benefits

  • Ability to avoid public hospital waiting lists – faster treatment.
  • Reduction in stress by choosing when you get that operation done (great for self employed) and less financial burden as it reduces the costs of private treatment.
  • Choice in where you receive treatment for your medical condition.
  • With some policies ability to access non government subsidised treatments (not all policies offer this).

Public System vs Private Insurance

If you are eligible for New Zealand healthcare there is a free system for acute needs an also an accident insurance scheme (ACC) which covers you for accidental injury. If you need access to a specialist, have non acute surgery or need a diagnostic procedure (CT scan etc), you will be put on a waiting list. Having private medical cover can mean you can get access to this treatment quickly.

Types of Health Cover

There are various forms of Health Insurance you can get in New Zealand, here is a brief summary of what you can get:

  • Base Plans (Surgical and Non- Surgical costs covered).
  • Specialists Costs (Specialists and tests covered if a GP refers you).
  • GP visits.
  • Dental and optical cover.

Generally in New Zealand the base plans and specialist costs are the most commonly recommended policies, simply because these cover the most expensive risks. Dental cover in New Zealand is limited in most cases to $400 per policy year so it would not cover expensive procedures such as titanium implants.

Pharmac & Non-Pharmac

There are quite a few drug treatments which have been proven successful overseas in treating conditions such as cancer for example. Not all these treatments are on the Pharmac list which means that only a few health insurance companies will pay for these. If having access to treatment outside the public system is important then you need to take this into consideration.

Health Insurers – Who We Use

Here we at Smart Insure we think that clients should have the choice of all companies products however at the same time we will show an independent rating of any products that we recommend.

Current health insurance companies we use are:

  • AIA Logo
  • Accuro Logo
  • NIB Logo
  • One Path Logo
  • Partner Life Logo
  • Southern Cross Logo

Health Insurance FAQ

How much does it cost?
Health insurance premiums are based on age, gender and smoking status, and also on the range of benefits that you choose to have on your plan.
What benefits can I have on my plan?
Generally in New Zealand most people have the base plan which covers surgical and non-surgical events and the other option they look at having is specialists and tests. There are several companies which offer GP visits, dental cover and optical costs however these can be expensive and generally you are dollar cost swapping.
What does the specialist & tests option offer?
If you have the base plan and require surgery then any specialist cost generally 6 months either side of that surgical event will be covered by the base plan. However if you see a specialist and don’t require surgery then this would only be covered under the specialist & tests option as you didn’t have surgery.
Do you offer discounted premiums?
For Health Insurance we do not offer discounted premiums because the margins are not high enough, however if you choose to have life or income protection insurance with your cover we offer an industry leading 30% rebate on your first year premiums for life and income protection insurances.
What is non Pharmac cover?
Basically if there is a treatment for cancer or an acute condition that is not on the pharmac list then this treatment does not attract a government subsidy. Not all health insurers will pay for non-pharmac treatment or only a small portion.
How do I make a claim?
You contact us to make a claim in first instance and ideally we like to apply for prior approval to make your life easier so you don’t need to apply for a refund.

Application FAQ

How Do I Apply?

So you have decided that you wish to apply for some health insurance, what’s the next step. We have the following options to make it easy for you:

  • Online access
  • Over the phone
  • Paper forms

The next step is to decide which option suits you best and then we can get the paperwork underway. We provide you with all the companies’ prices and then add a discount and then provide the 3rd party research so you can make your own informed decision and/or consult with one of our qualified expert insurance advisers if you have further questions.

Next Step

Fill in the application form over the phone, online or the paper based application. This is then submitted to the insurance company, depending on what you are applying for and your medical information this may be it. If there is no further information needed all we need is a signed declaration page and a direct debit form filled out which you can do online and that is it.

Further Information Required

Depending on what you are applying for or your medical history the following may occur:

  • Telephone call required from insurance company or Smart Insure to get further information
  • Medical information requested from your GP
  • Medical test or blood tests requested by the insurance company

Once all the information the insurance company requires is received they will come to an underwriting decision which will either be assessed as standard or with special conditions. Special conditions are either an increase in premium or an exclusion where something will not be covered under your insurance cover; i.e. a shoulder exclusion.

How Long Does It Take To get Into Place?

This really depends on whether we need to obtain your medical records and need any further medical tests done. Generally a health insurance policy which has no medical requirements or records needed can be in place within 2-3 days.

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