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Health Insurance Explained (Medical Cover)

There are three different ways health insurance providers have produced products in the New Zealand market. They fall under the general categories of comprehensive cover, hospital & surgical cover and modular cover.

  • Comprehensive cover provides the maximum amount of benefits which includes:
    doctor (including specialists) visits
    dental costs
    optical costs

  • Hospital & surgical cover provides for only the "big ticket" items like chemotherapy, specified non-surgical procedures, hospitalisation and surgery.

  • Modular cover provides a "do it yourself" bespoke policy where initially the policy only has a basic hospital and surgery plan, but the individual may add modules that they choose from the comprehensive range of products that they want.

When considering medical insurance it's extremely important to "shop around". This is because premiums are constantly on the rise and will keep on rising. Close scrutiny is essential in order to determine the "best value for money" against what is covered exactly as there may be exclusions, for example there are probably no products available that cover elective cosmetic surgery. The events to pay close attention to are as follows:

  • dental visitation

  • hospital expenses

  • surgery expenses

  • doctor visitation

  • specialist visitation

  • optician visitation

  • surgical cover that is completed without hospitalisation (example maybe a colonoscopy)

  • diagnostic consultations

Premiums are calculated on a case by case basis and will be determined by age and health of the individual applying. This may include exclusions depending on any pre-existing medical conditions.
There will be "terms and conditions" which need to be carefully considered and understood. Generally these may include the following, in that they are not covered by the policy:

  • organ transplants

  • treatments covered by ACC

  • pre-existing conditions

  • acute care

  • excess conditions for specified procedures

  • a maximum limit

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