Health insurance on New Zealand

A major health problem can put your life on hold. To get back to living you need to get quality advice and treatment – and you need to get it quickly.

Health insurance on New Zealand
As you’ll know, NZ’s public health system still provides good services for emergency situations (like a car crash) but for other health problems - even very serious ones, like cancer treatment – you can spend months or even years on a waiting list. If you have health insurance you won’t need to wait; you can access high quality treatment quickly and focus on getting better.

How do you choose the right health insurance plan?
If getting quality, affordable NZ health insurance is your aim there are some rules to follow (and some traps to avoid).

Choose the right health insurance plan
Making the right health insurance choice is not always easy, and it’s not a matter of just comparing premiums and brochures. Your Inform adviser can explain the finer points of the different plans on the market - but to get you started, here's a look at health insurance ‘must haves’ that you need to know about.

Get major medical health insurance.
The first thing your health insurance plan must do is pay for 100% of the cost of treatment in hospital. These days private hospitalisation costs can be huge (easily many tens of thousands of dollars and sometimes even more). Your plan needs to offer 100% cover for these. If it doesn’t, then keep looking.

But there’s a bit more to it
Your health insurance also needs to cover non-surgical hospitalisation (cancer treatment like chemotherapy for example), and it needs to cover it well. It’s a little known fact that most health insurance plans on the market don’t cover this area adequately - so you need to check this point carefully.

Don’t forget specialists and tests.
Some health insurance plans will also pay for test and specialist costs that occur before and after your hospital treatment. These usually cost less than hospital treatment, but they can certainly add up, so your health insurance needs to pay for these as well.

What about cover for GPs, dental costs, etc?
There are two traps here. First of all, many health insurance plans do cover these expenses, but don’t properly cover the costs that really matter: hospital costs (this is kind of like insuring your car against getting a scratch, but not against a major crash). It means that if you face really expensive treatment, your health insurance is next to useless.
The other trap? Some good major medical plans do include optional add-ons for the smaller costs, however these will easily double the cost of your health insurance. And once you read the fine print you’ll pretty quickly see that the cost of the insurance is more than you could usually possibly claim (to give a simplified example you might be paying $500 a year, but can only claim $450). So these add-ons just don’t make sense.

Watch out for limits and maximums.
Broadly speaking, plans can cover your costs in two ways. One is to give a long list of various medical treatments and procedures and assign each one a dollar value (for example: Surgeons fee - $6000 per operation, Laparoscopic disposables - $4500 per operation). The dollar value is the maximum that the plan will pay. The other option is to give a total amount that the plan will pay (for example: Surgery - $250 000 per annum). Because future medical costs are so hard to predict, we feel that our clients have better protection with the second option.

What about pre-existing conditions?
A pre-existing condition is basically a health issue that you know about (or suspect), that occurred before you start your health insurance. NZ health insurance plans are usually not designed to cover pre-existing or recent health problems, so treatment relating to the pre-existing condition will usually be excluded from your health insurance (this means that the plan won’t pay for costs relating to this issue). Some pre-existing issues will be permanently excluded from the health insurance, while others can sometimes be covered after a period of time. Or the insurer might charge a higher premium to cover the issue. There is a lot of variation here, so while it’s always personal, it’s important to discuss pre-existing or recent health issues with your adviser – as this might have a big impact on the health insurer that’s right for you.

When is the right time to get health insurance?
Are you young and relatively healthy? Then you may think you don't need health insurance - in fact this is the time you ought to be looking into it. Why? It's all about your future insurability. If you suffer a sickness or an injury before getting covered, that condition can be permanently excluded from your health cover for the rest of your life.

How do you make sure your claim will be paid?
This is not as simple as choosing the ‘right’ insurer, in fact it’s more about choosing the right adviser. Your adviser can make sure you give the correct info when applying for the insurance (reducing the risk of accidentally leaving off important health details). They will help you select an insurer that they know pays claims fairly and quickly (advisers see the insurers’ claims processes every day, so know which insurers are fair and which aren’t).

Also, your adviser will help you with making a claim. They’ll give advice on the best way to complete the claim paperwork, they’ll liaise with your medical specialists if need be, and they’ll be in communication with your insurer. Basically they’ll be on your side, and working on your behalf.
More on health insurance options
Consider an excess. The excess is the part of the medical bill that you pay (for example if your medical bill is $10 000 and your excess is $250, your insurer will pay $9 750 and you pay $250). Most plans will offer a wide range of excess options (the higher your excess the lower your premiums will be). This gives you more control over what you'll pay for your health cover
What is the additional 'Specialists & Tests' option? Many good plans offer this add-on, and the way it works is pretty straight-forward. Most good health insurance plans will pay for specialist consultations and test costs that occur before and after your hospital treatment. However if hospitalisation is not needed, the cost wouldn’t usually be covered. Some plans also give an option so that visits to specialists and recommended tests are always covered - whether or not they relate to hospital treatment. This is often referred to as the 'Specialists and Tests' option.
What about all the other optional extras – chiropractors, alternative treatment, and so on? First of all, choose a health plan on the strength of how it performs in the must-have areas above, not on the number of bells and whistles it has, otherwise you run the risk of choosing a health insurance plan that will leave you high and dry if you face a large hospital bill. For the smaller costs, an idea that works for our clients is to start your own ‘health fund’ (which can be just an interest bearing bank account). Pop a bit of money into this regularly and dip into it for your smaller medical expenses. The best part? If you don’t use that money it’ll be yours -not the insurance company’s!

Source : http://www.inform.co.nz/health-insurance/