Frequently asked questions
- Do I have to complete a claim form before I go to the specialist or hospital?
We recommend you complete a “prior-approval” form and if accepted the insurer will pay the invoice directly. All you are left to pay is the excess (if applicable). However in some cases there is no time for a prior approval and you end up paying the health provider and then the insurer will reimburse you.
- Am I able to choose which specialist or private hospital I go to?
This can depend upon the health insurer and sometimes they prefer you to go to one of their affiliated providers. This is not always the case and often your GP or Specialist will make a recommendation.
- If I don't choose the Specialists & Tests benefit, would they be covered?
Each company is different but generally if a procedure is performed by an affiliated provider it will be covered normally for 6 months before and after hospitalisation.
Some specific major diagnostic tests would be covered whether they leads on to surgery or not.
- Are GP and dentist visits covered?
The cost to cover doctor’s visits is usually too high and we recommend (in normal circumstances) that you stick with Hospital Cover (and additional Specialists and Tests if you'd like extra cover).
Cover for dental costs is not recommended (again the cost factor), although all plans cover oral surgery.
- How does the excess work?
The "excess" is the portion of the medical bill that you pay at claim time. Applying an excess is one way to lower the premium.
- Will my premiums increase in the future?
Premiums can increase from 10 – 15 % and are in line with your age and the increasing cost of health care.
- What is an affiliated provider?
This is a provider that has been approved by the insurer.
- Are premiums affected if I smoke?
Definitely. Premiums are significantly lower for non-smokers. Once you have been smoke-free for 12 months you are classified as a non-smoker.
- If I have pre-existing conditions will they be covered?
Usually health insurers don't cover pre-existing conditions. On the application you will be asked to provide your medical history and then the insurer will assess whether any condition that you may have had or currently have, will be covered. You will be advised of this.
- What is an "exclusion"?
An exclusion is something not covered by the policy and some exclusions for example cosmetic surgery are built into the policy.
- Is pregnancy covered?
Normal costs associated with pregnancy are not covered by health insurance, though in some cases a pregnancy complication would be covered. Fertility treatment is not covered.
- Am I covered while travelling overseas or if I moved overseas?
In most cases (not all), you cannot claim while you are travelling overseas, however you would be covered for the treatment when you return to New Zealand. Travel Insurance is recommended. If you are moving permanently overseas, we would recommend that you cancel the policy.