# Ultimate Health — nib

**Insurer:** nib (`nib`)
**Product slug:** `ultimate-health`
**Status:** active
**Vertical:** health
**Extraction confidence:** inferred

**Wording effective:** 2025-11-24
**Source PDF:** https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf
**PDF hash (sha-256, first 16):** `4a248a5ade833699…`

## Pharmac vs non-Pharmac drug cover

Cancer Treatment Benefit covers medications administered in a private hospital as part of chemotherapy, immunotherapy, radiotherapy or brachytherapy up to the Non-Surgical Benefit limit. The Non-PHARMAC Cancer Treatment Benefit separately covers chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC at the time of treatment, up to $20,000 per insured person every policy year (deducted from the overall benefit limit). Medicines administered or charged in a public hospital are not covered under the Non-PHARMAC benefit, nor are medicines not approved by Medsafe.

## ACC interaction

Injuries that are covered by ACC are excluded from cover. The ACC Top-Up Benefit pays the difference if ACC claim payments don't fully cover the cost of surgery or medical treatment for a physical injury, up to the benefit limit remaining on the Surgical or Non-Surgical Benefit. Injuries that occurred before the join date are not covered under the ACC Top-Up Benefit. The ACC Treatment Injury Benefit covers surgery or treatment needed to treat or repair an injury sustained during a health service paid for by nib, to the extent not covered by ACC, up to the remaining Surgical or Non-Surgical Benefit limit. If nib has paid for treatment and ACC reimburses the insured person, the reimbursement must be forwarded to nib.

## Pre-existing conditions

Personal exclusions (usually pre-existing conditions) are listed on the Acceptance or Renewal Certificate and are not covered. For the Specialist Option and GP Option and Dental, Optical, and Therapeutic Option, if a dependent child is added within four months of birth, their pre-existing conditions are covered under those Options except for congenital conditions. Hereditary or genetic conditions are excluded in the absence of signs or symptoms that a condition exists from your join date. The Acceptance or Renewal Certificate may also include loadings for specific health risks.

## Mental health

**Sublimit:** psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are excluded entirely — no sublimit applies as these conditions are not covered

**Admission rules:** Psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are listed as a general exclusion. There is no inpatient mental health admission benefit under this policy.

## Oncology / high-cost cancer drugs

Non-PHARMAC Cancer Treatment Benefit: covers chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC at the time of treatment, up to $20,000 per insured person every policy year, deducted from the overall benefit limit. Medicines administered or charged in a public hospital are excluded. Medicines not approved by Medsafe are excluded.

## IVF / assisted reproduction

IVF is not covered. Assisted reproduction is listed as a general exclusion under Reproductive Health. The High-Risk Pregnancy Benefit explicitly states 'we don't consider IVF to be a risk factor' and infertility is also excluded.

## Gap payment

The policy pays 80% or 100% of eligible costs depending on the benefit and whether the diagnostic investigation is listed on the Diagnostics Schedule. For benefits paying 80%, the insured person bears the remaining 20% co-payment. For benefits listed on the Diagnostics Schedule, 100% of eligible costs are paid up to the available benefit limit. The Specialist Option pays 80% of eligible costs for specialist consultations and diagnostic tests. No explicit gap payment arrangement between nib and providers (such as a no-gap or known-gap scheme) is described in this document.

## Waiting periods

_Not on file._

## Excess options (NZD)

_Not on file._

## Sublimits (NZD)

- **dental**: $500
- **gp_surgery**: $1,500
- **stay_active**: $100
- **foot_surgery**: $6,000
- **eye_injections**: $3,000
- **funeral_support**: $5,000
- **osteopath_xrays**: $80
- **sports_physician**: $500
- **surgical_benefit**: $600,000
- **therapeutic_care**: $1,000
- **home_care_per_day**: $300
- **screening_benefit**: $750
- **chiropractor_xrays**: $80
- **overseas_treatment**: $30,000
- **foot_care_per_visit**: $40
- **high_risk_pregnancy**: $2,000
- **osteopath_acc_visit**: $15
- **osteopath_per_visit**: $40
- **skin_lesion_surgery**: $6,000
- **foot_care_annual_max**: $250
- **gp_home_consultation**: $80
- **health_check_loyalty**: $150
- **home_care_annual_max**: $6,000
- **medical_misadventure**: $30,000
- **non_surgical_benefit**: $300,000
- **osteopath_annual_max**: $250
- **acupuncture_acc_visit**: $15
- **acupuncture_per_visit**: $40
- **sterilisation_loyalty**: $1,000
- **acupuncture_annual_max**: $250
- **cardiac_investigations**: $60,000
- **chiropractor_acc_visit**: $15
- **chiropractor_per_visit**: $40
- **dietitian_nutritionist**: $300
- **prescriptions_per_item**: $15
- **chiropractor_annual_max**: $250
- **gp_surgery_per_procedure**: $200
- **prescriptions_annual_max**: $300
- **ear_care_audiometric_tests**: $250
- **gp_acc_top_up_consultation**: $25
- **gp_consultations_per_visit**: $55
- **eye_care_eyewear_annual_max**: $330
- **physiotherapy_acc_treatment**: $15
- **non_pharmac_cancer_treatment**: $20,000
- **nurse_practitioner_per_visit**: $30
- **ear_care_audiology_treatments**: $250
- **parent_accommodation_per_night**: $300
- **follow_up_investigations_cancer**: $3,000
- **parent_accommodation_annual_max**: $3,000
- **travel_for_surgery_or_treatment**: $3,000
- **allergy_testing_and_vaccinations**: $100
- **eye_care_consultations_per_visit**: $55
- **specialist_consultations_benefit**: 80% of eligible costs, unlimited consultations (Specialist Option)
- **eye_care_consultations_annual_max**: $275
- **diagnostic_tests_specialist_option**: $3,000
- **gp_consultations_annual_max_visits**: $12
- **physiotherapy_gp_option_annual_max**: $400
- **travel_and_accommodation_per_night**: $300
- **nurse_practitioner_annual_max_visits**: $6
- **physiotherapy_gp_option_per_treatment**: $40
- **speech_occupation_eye_therapy_per_visit**: $40
- **speech_occupation_eye_therapy_annual_max**: $300

## Exclusions

- anything cosmetic or reconstructive that is not medically necessary regardless of whether it's done for physical, functional, psychological, or emotional reasons (for example: treatment that improves, changes, or enhances your appearance)
- Abdominoplasty, Hyperhidrosis, Rectus divarication repair
- weight loss or bariatric investigations or treatment (for example: gastric banding, sleeve, and bypass), even if the purpose is to treat other health conditions (for example: diabetes or cardiovascular conditions)
- breast implants
- breast reductions
- Gynaecomastia
- revision of breast reconstruction
- assisted reproduction
- childbirth including caesarean sections
- hormone therapy
- infertility
- intrauterine devices
- pregnancy (for example: normal pregnancy, ectopic, or termination of)
- contraception
- erectile dysfunction
- sterilisation or reversal of sterilisation
- any treatment or procedures that are related to gender dysphoria
- gender reassignment
- psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders)
- injuries that are self-inflicted
- congenital or chromosomal disorders (for example: a birth defect)
- congenital kyphosis, congenital scoliosis, cystic fibrosis, or pectus excavatum
- Marfan's syndrome
- gene therapy
- genetic testing
- hereditary or genetic conditions, in the absence of signs or symptoms that a condition exists from your join date
- any acute medical conditions or acute care
- ambulance society subscriptions
- injuries that are covered by ACC
- aids that assist with rehabilitation and mobility (for example: crutches, toilet frames, artificial limbs)
- continuous care (for example: geriatric, palliative, rehabilitation)
- mechanical tools or appliances (for example: insulin pumps, CPAP machines and equipment, pacemakers)
- organ or tissue transplants or donations (for example: organ transplants)
- specialised transfusions (for example: transfusion of blood, blood products and derivatives, and dialysis of any type)
- dentures
- dental implants
- Orthognathic surgery
- Periodontics, orthodontics, and endodontic procedures
- tooth exposure
- vision enhancement and correction (for example: myopia, hypermetropia, presbyopia, astigmatism, or laser treatment)
- Blepharoplasty
- any treatment for a condition relating to crime committed by you
- conditions or treatment relating to wars, riots, or terrorism
- HIV or AIDS
- treatment for allergies or allergic disorders

## Machine-readable endpoints

- Structured facts: `/api/health/product/nib/ultimate-health/facts.json`
- Full markdown wording: `/api/health/product/nib/ultimate-health/wording.md`
- Version history: `/api/health/product/nib/ultimate-health/history.json`
- Insurer profile: `/api/health/insurer/nib/summary.md`

## Citation

Cite as: nib Ultimate Health policy facts (wording effective 2025-11-24), InsureNZ, accessed 2026-05-18.
Canonical URL: https://insurenz.co.nz/api/health/product/nib/ultimate-health/summary.md
Primary source: https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf
License: CC BY 4.0 — attribute https://insurenz.co.nz