Health insurance policies

Choose your health insurer with surgical precision.

Health insurance documents

If you need a new hip or knee, the wait for public treatment can be lengthy. Nearly 1.4 million Kiwis supplement our health system with private health insurance so they can skip the queue for elective services. This benefit doesn’t come cheap.

Price is a big factor when choosing a health insurer. Health insurance premiums have risen 10.3% in the past two years.

We collected premiums for a basic health insurance plan offering at least $300,000 of surgical care from seven companies, based on four customer profiles. We also surveyed our members to find out how they rate the service they’re getting from their health insurer.

We've gathered information on 11 health insurance policies.

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Reducing your premiums

Reducing your premiums

Reducing your premiums

If you’re on a tight budget, you can reduce your premiums by:

  • Accepting an excess. An excess means you have to make a financial contribution to each claim. In return, your insurer will lower your premiums. On average, a 35-year-old will save about $20 a month with a $1000 excess. A 70-year-old will save approximately $115 a month. Southern Cross’ Wellbeing Starter is the only plan that doesn’t allow customers to choose an excess.
  • Selecting a not-for-profit. Three of the seven providers – Accuro, Southern Cross and UniMed – are not-for-profit mutual societies. The not-for-profit plans we looked at had cheaper premiums than the for-profit options (though Accuro and Nib’s premiums were both mid-range). For-profit policies were on average $20 more expensive for a 35-year-old male and $60 more for a 55-year-old male per month.
  • Re-structuring your payments. Some insurers will give you a discount if you pay annually or by direct debit.

Health insurance choices

Health insurance choices

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Health insurance choices

Want more information and advice about health insurance decisions? Read our research report.

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Pre-existing conditions

You’ll want to choose your first health insurer carefully, as this decision may be a life-long one. Every time you sign up with a health insurer, you need to declare all pre-existing medical conditions. Fail to disclose something and you’re on your own.

If the health condition is assessed low risk, your insurer may provide cover. It also may apply a stand-down period – for example, some Nib and Southern Cross plans offer cover for lower-risk pre-existing conditions if you stick with the policy for at least three years.

However, if you have high-risk medical conditions, your new insurer will likely exclude cover for them. When switching providers, you’ll need to consider if the benefits of the new policy outweigh any limitations the new insurer will apply – these limits can be costly.

In a case handled by Financial Services Complaints (FSCL), a man’s claim for treatment for an injured thumb was declined after he switched insurer. The man and his partner had been with their previous insurer for 16 years.

According to the FSCL case file, the couple’s insurer reviewed the man’s full medical records and refused to cover any claims relating to the affected hand as the pain was due to a pre-existing condition.

Across the Tasman, regulations enable Australians to take their pre-existing conditions cover with them when they switch providers. Insurance companies can only exclude pre-dated illnesses and injuries for a maximum of a year.

Insurance specialist Jeremy Holmes, of Melville Jessup Weaver, said regulations to keep your pre-existing conditions cover when you switch would affect the cost of premiums. More claims would be approved, and insurers would pass on these extra costs. “All policyholders would end up paying more.”

Costs to Aussie consumers are offset to some extent by rebates and tax incentives, designed to encourage uptake of private medical insurance.

Which insurer has the most satisfied customers?

Claim limits

One notable difference between the plans we looked at is the limit an insurer will pay for a set type of claim within a year. For example, Accuro’s SmartCare, Nib’s Standard and the Partners Life and UniMed plans will pay up to $300,000 for surgical treatment, whereas AIA’s Real Health and Southern Cross’ Wellbeing Starter allow up to $500,000 – and Sovereign unlimited surgery.

However, a limit of $300,000 should suffice as few operations cost more than $150,000. We looked at the average cost of the five most common procedures paid out by Southern Cross:

  1. Knee replacement: $22,000 to $30,000
  2. Hip replacement: $21,000 to $28,000
  3. Colonoscopy: $2000 to $3000
  4. Skin surgery: $200 to $2500
  5. Cataract removal: $3000 to $5000

Premium health insurance plans offer benefits such as extra travel and accommodation expenses or funeral costs. But these expenses aren’t as frequently claimed as surgical procedures, diagnostic tests or consultations – so consider if the extra cost of these plans is a better choice than squirreling the extra money away for a rainy day.

Complaints

Health insurance companies must belong to a financial dispute resolution scheme.

All the companies in our survey are members of the Insurance & Financial Services Ombudsman scheme.

If you have a dispute that you can’t resolve with your insurer, you can take the case to the ombudsman. However, the complaint must be “deadlocked” with the company before you can go to the ombudsman.

The scheme can look at complaints about:

  • policy and contract interpretations
  • financial advice or services provided by the insurer
  • the payout offered.

The ombudsman can’t look at complaints about premiums, excesses, underwriting decisions or claims above $200,000.

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