Health Insurance NZ - Compare Plans from Southern Cross, nib & AIA | InsureNZ

What is Health Insurance in New Zealand?

Health insurance in New Zealand provides private medical coverage that complements the public healthcare system. While New Zealand's public health system provides essential care, health insurance offers faster access to specialists, shorter waiting times for elective surgery, choice of specialist and hospital, and comprehensive coverage for a wide range of medical treatments and procedures.

Approximately 1.4 million New Zealanders (30% of the population) have some form of private health insurance. With public system waiting times for elective surgery often extending 6-18 months, and specialist appointments taking 3-6 months, health insurance provides peace of mind and timely access to medical care when you need it most.

Types of Health Insurance Coverage

Surgical and Specialist Cover

The most common type of health insurance in New Zealand covers surgical procedures and specialist consultations. This includes operations in private hospitals, pre and post-operative care, specialist consultations, diagnostic tests like MRI and CT scans, and follow-up treatments. Policies typically cover both day surgery and inpatient procedures, with accommodation in private or semi-private hospital rooms.

Comprehensive Medical Insurance

Comprehensive plans extend beyond surgical cover to include GP visits, prescription medications, physiotherapy, mental health services, alternative therapies like osteopathy and acupuncture, and broader diagnostic testing. These plans offer the most extensive coverage but come with higher premiums, typically costing 40-60% more than surgical-only plans.

Everyday Health or Wellness Plans

Wellness plans cover routine healthcare expenses not typically included in standard health insurance. This includes dental checkups and fillings, optical services including eye tests and glasses, GP consultations, prescription medications, physiotherapy, and preventive health screenings. These plans work alongside or separately from major medical insurance, with annual benefits typically capped at $500-$2,000.

Hospital Cash Plans

Hospital cash insurance pays a daily benefit if you're hospitalized, regardless of costs incurred. Benefits typically range from $100-$500 per day and can be used however you choose - covering lost income, childcare, or additional medical expenses. These affordable plans (usually $15-$40 monthly) complement other health insurance or provide basic financial protection during hospitalization.

How Much Does Health Insurance Cost in NZ?

Health insurance premiums vary significantly based on age, coverage level, excess, and provider. Here are typical monthly costs for New Zealand health insurance in 2024:

Individual Coverage (per month):

Ages 18-30: $50-$120 (basic), $80-$180 (comprehensive)
Ages 31-45: $80-$150 (basic), $120-$250 (comprehensive)
Ages 46-60: $120-$220 (basic), $180-$350 (comprehensive)
Ages 61+: $180-$350 (basic), $280-$500 (comprehensive)

Family Coverage (per month):

Couple: $150-$300 (basic), $220-$450 (comprehensive)
Family (2 adults + 2 children): $200-$400 (basic), $300-$600 (comprehensive)

Additional Covers (per month):

Wellness/Dental & Optical: $20-$60
Hospital Cash Plans: $15-$40

What Affects Your Health Insurance Premium?

Age: Premiums increase with age, typically rising 3-5% annually as you age, with significant jumps at ages 50, 60, and 70.
Coverage Level: Comprehensive plans with low annual limits cost 40-60% more than basic surgical-only plans.
Excess: Choosing higher excesses ($300-$500 vs $0) can reduce premiums by 15-25%.
Smoking Status: Smokers typically pay 10-20% more than non-smokers for health insurance.
Pre-existing Conditions: May result in premium loadings of 25-50% or permanent exclusions depending on severity.
Occupation: High-risk occupations may attract premium loadings of 10-30%.
Family History: Significant family history of serious conditions may affect premiums for comprehensive plans.
Annual Limits: Plans with higher annual benefit limits ($50,000 vs $100,000) cost more but provide greater protection.

Comparing Major Health Insurance Providers

Southern Cross Health Insurance

Southern Cross is New Zealand's largest health insurer with approximately 60% market share and over 870,000 members. Founded in 1961, they offer the most extensive network of affiliated providers and medical facilities nationwide. Southern Cross provides surgical cover, comprehensive medical plans, wellness add-ons, and specialist networks across New Zealand. Their premiums are typically mid-range to premium, but their extensive provider network and established reputation provide strong value. They offer benefits like Fast Track Elective Surgery and Well Health programs.

nib Health Insurance

nib holds approximately 15% of the New Zealand health insurance market and is known for competitive premiums and straightforward policies. Originally founded in Australia in 1952, nib entered the NZ market and has grown through competitive pricing and comprehensive coverage options. They offer surgical and specialist cover, comprehensive medical plans, everyday health extras, and travel insurance integration. nib often provides more affordable premiums than Southern Cross, particularly for younger members and basic plans.

AIA Health Insurance

AIA, a major Asia-Pacific insurer with significant NZ presence, integrates health insurance with their life insurance products. They offer comprehensive health coverage with competitive premiums for bundled policies. AIA provides surgical and specialist cover, wellness programs, and vitality rewards for healthy living. Their premiums are competitive, particularly when combining health with life insurance. AIA's unique Vitality program rewards members for healthy behaviors with premium discounts up to 25%.

Accuro Health Insurance

Accuro is a smaller, NZ-owned health insurer offering personalized service and competitive premiums. They focus on straightforward policies without complex exclusions and offer flexible payment options. Accuro provides surgical cover, specialist consultations, and optional everyday health benefits. Their premiums are often 10-20% below Southern Cross for equivalent coverage, making them popular with price-conscious consumers seeking quality coverage.

What's Typically Covered by Health Insurance?

Usually Covered:

Surgical procedures in private hospitals
Specialist consultations and follow-ups
Diagnostic tests (MRI, CT, ultrasound, blood tests)
Cancer treatment including chemotherapy and radiotherapy
Day surgery and outpatient procedures
Pre and post-operative care
Hospital accommodation (private or semi-private)
Surgical dental procedures
Physiotherapy (with limits)
Mental health treatment (some policies)

Usually NOT Covered:

Pre-existing conditions (permanent exclusion or 3-5 year waiting period)
Cosmetic or elective aesthetic procedures
Routine dental care (unless wellness plan included)
Routine optical care (unless wellness plan included)
Pregnancy and childbirth (some policies cover complications)
Treatment for self-inflicted injuries
Experimental or unproven treatments
Treatment received outside New Zealand (unless travel insurance included)
Organ transplants (most policies)
Injuries from hazardous activities without disclosure

Understanding Waiting Periods

Health insurance policies have waiting periods before you can claim for certain treatments. Understanding these helps avoid surprises:

Accident Cover: Immediate or 48 hours - injuries from accidents are covered almost immediately.
Surgical Procedures: 6 months - most elective surgical procedures require a 6-month waiting period.
Pre-existing Conditions: 3-5 years if covered at all - conditions existing before policy commencement face lengthy waiting periods or permanent exclusion.
Pregnancy: 12 months (if covered) - most policies exclude pregnancy, but some cover complications after 12 months.
Optical and Dental Extras: 2-6 months - wellness benefits often have shorter waiting periods.

Note: Many insurers waive waiting periods if you're transferring from another health insurer with equivalent or better coverage, making it easier to switch providers without losing coverage continuity.

Regional Health Insurance Considerations

Auckland Health Insurance

Auckland offers the widest choice of private hospitals and specialists in New Zealand, including Mercy Hospital, Auckland Surgical Centre, and Ascot Hospital. With longer public system wait times than rural areas (specialist appointments often 4-6 months), private health insurance is particularly valuable. Auckland's diverse medical community means excellent specialist access across all medical fields. Premiums don't vary significantly by region, but Auckland residents have the greatest choice of affiliated providers.

Wellington Health Insurance

Wellington has excellent private healthcare facilities including Bowen Hospital and Wellington Private Surgical. The capital's public health system faces significant pressure, with elective surgery wait times often exceeding 12 months. Health insurance provides Wellington residents faster access to diagnostics and treatment. The city's concentration of government workers means many have employer-subsidized health insurance.

Christchurch Health Insurance

Christchurch offers quality private healthcare through facilities like St George's Hospital and Southern Cross hospitals. Following the earthquakes, healthcare infrastructure has been rebuilt and improved. While public system wait times are generally shorter than Auckland, health insurance still provides significant advantages for specialist access and elective surgery. Christchurch has competitive health insurance pricing with good provider networks.

Regional and Rural NZ Health Insurance

Rural New Zealanders face unique healthcare challenges including distance to specialists and limited local private facilities. Health insurance helps by covering travel to specialist appointments in major centres, providing accommodation benefits for treatment away from home, and ensuring access to affiliated providers nationwide. While premiums don't differ by region, rural residents should ensure their policy includes travel and accommodation benefits.

How to Choose the Right Health Insurance

Selecting appropriate health insurance requires careful consideration of multiple factors:

Assess Your Health Needs: Consider your age, current health, family medical history, and likelihood of requiring surgery or specialist care.
Set Your Budget: Determine what monthly premium you can comfortably afford long-term, remembering premiums increase with age.
Choose Coverage Level: Basic surgical cover suits young, healthy individuals. Comprehensive plans better suit those with health concerns or family history.
Consider Extras: Decide if dental, optical, and GP visit coverage would provide good value for your situation.
Compare Annual Limits: Ensure annual benefit limits are sufficient (minimum $50,000 recommended, $100,000 better).
Review Excess Options: Balance lower premiums against higher out-of-pocket costs when claiming. Can you afford a $500 excess?
Check Provider Networks: Ensure your preferred specialists and hospitals are covered under the policy's affiliated provider network.
Read Policy Exclusions: Understand what's not covered, particularly regarding pre-existing conditions and waiting periods.

Making a Health Insurance Claim

The claims process for health insurance is generally straightforward. For planned procedures, contact your insurer before booking to confirm coverage and get pre-approval. Provide your specialist's recommendation and treatment plan. The insurer will confirm coverage, any excesses payable, and whether they'll pay the provider directly or reimburse you.

For affiliated providers, most insurers pay directly, requiring you only to pay the excess. For non-affiliated providers, you typically pay upfront and claim reimbursement. Submit claims with invoices, receipts, and medical reports within the specified timeframe (usually 90 days). Most straightforward claims are processed within 5-10 business days.

Keep all medical documentation including specialist letters, test results, invoices, and receipts. If a claim is declined, insurers must provide written reasons. You can appeal decisions or contact the Insurance and Financial Services Ombudsman if unresolved.

Ways to Save on Health Insurance

Start Young: Premiums are lowest in your 20s and 30s. Starting early locks in lower base rates that increase more gradually.
Choose Higher Excesses: Increasing your excess from $0 to $300-$500 can reduce premiums by 15-25%.
Compare Annually: Shop around each renewal. Insurers offer competitive rates for new customers - switching can save $200-$500 annually.
Bundle Policies: Some insurers discount when combining health with life insurance (savings of 5-10%).
Join Through Employer: Employer group schemes often provide 10-30% discounts plus potentially subsidized premiums.
Pay Annually: Annual payments typically save 5-8% compared to monthly installments.
Consider Basic Plans: If you're young and healthy, basic surgical cover may suffice rather than comprehensive plans.
Maintain Healthy Lifestyle: Some insurers like AIA offer premium discounts (up to 25%) for healthy living through wellness programs.
Review Coverage Regularly: Ensure you're not over-insured. Adjust coverage as circumstances change.

Frequently Asked Questions

What does health insurance cover in New Zealand?

Health insurance in NZ typically covers surgical procedures, specialist consultations, diagnostic tests, medical procedures, hospital accommodation, and some dental and optical services. Coverage varies by policy level, with comprehensive plans offering wider benefits than basic plans.

How much does health insurance cost in NZ?

Health insurance in New Zealand typically costs between $50-$300 per month for individuals, depending on age, coverage level, and excess chosen. Family plans range from $150-$600 monthly. Comprehensive plans with low excesses cost more than basic plans.

Do I need health insurance if I have public healthcare?

While New Zealand has a public healthcare system, health insurance provides faster access to specialists and elective surgery, choice of specialist and timing, private hospital accommodation, and comprehensive diagnostic testing without long waiting periods that can extend to months or years in the public system.

What's the difference between Southern Cross and nib?

Southern Cross holds 60% of NZ's health insurance market and offers the widest network of affiliated providers. nib holds 15% market share and often offers competitive premiums with comprehensive coverage. Both offer surgical, specialist, and diagnostic cover, but differ in pricing, network size, and additional benefits.

Can I get health insurance with pre-existing conditions?

Yes, but pre-existing conditions are typically excluded from coverage permanently or for a waiting period (usually 3-5 years). Some insurers offer limited coverage for pre-existing conditions or may load premiums. It's important to declare all pre-existing conditions to avoid claim rejection.

What is a health insurance excess?

A health insurance excess is the amount you pay towards each claim before insurance covers the rest. Excesses typically range from $0-$500 per claim or per year. Choosing higher excesses reduces monthly premiums but increases out-of-pocket costs when you claim.

Does health insurance cover dental and optical?

Basic health insurance typically doesn't cover routine dental and optical. However, many insurers offer optional extras or separate wellness plans covering routine dental checkups, fillings, glasses, and contact lenses. Surgical dental work is often covered under medical policies.

What are waiting periods for health insurance?

Health insurance typically has waiting periods: 6 months for surgical procedures, 12 months for pre-existing conditions (if covered), and immediate cover for accidents. Some insurers waive waiting periods if you're transferring from another health insurer with equivalent or higher cover.

Can I claim on both public and private health insurance?

You cannot claim twice for the same treatment. If you choose public healthcare, your private insurance won't pay. Health insurance is designed to cover private treatment costs. However, you can choose private insurance for some treatments while using public healthcare for others.

How do I choose the right health insurance plan?

Consider your age, health status, family medical history, budget, desired coverage level, and whether you want extras like dental and optical. Compare annual limits, excesses, specialist networks, and what's excluded. Younger, healthy individuals may prefer basic plans while families often benefit from comprehensive coverage.

Compare Health Insurance in New Zealand