What to Look Out for When Choosing a Health Insurance Policy

Choosing the right health insurance policy can be overwhelming, especially with a chronic illness. Here’s a guide to help you avoid common pitfalls and find the best option.

Key Things to Consider Before Signing Up

1️⃣ Will They Cover Your Pre-Existing Condition?

• Some insurers exclude all pre-existing conditions permanently.
• Others may cover them after a waiting period (e.g., 3 years of no treatment).
• Check the fine print! Some conditions (e.g., diabetes, arthritis) are always excluded.

2️⃣ What Does the Policy Actually Cover?

🔍 Look for:
✅ Specialist & Diagnostic Tests – X-rays, MRIs, blood tests.
✅ Non-Pharmac Medications – Medications not covered by NZ’s public system.
✅ Hospital & Surgery Cover – Some plans limit this.
✅ Allied Health (Physio, Occupational Therapy, Mental Health Support) – Some plans exclude these.
✅ Dental & Vision Add-Ons – Often not included unless you choose a specific policy.

3️⃣ What Are the Costs?

💰 Monthly Premiums: How much does it cost per month?
💰 Excess (Out-of-Pocket Cost): How much do you pay before insurance kicks in?
💰 Co-Payments: Some policies require you to pay part of the cost.

Example: A policy may cost $50/month but require you to pay the first $500 of any claim.

4️⃣ Are There Any Annual Limits?

• Some policies cap how much you can claim per year.
• Example: $500 for GP visits, $2,000 for specialist care, etc.
• Make sure the limits match your medical needs.

5️⃣ How Long Are the Waiting Periods?

• Some benefits only kick in after 6 months – 3 years.
• If you need urgent care, choose a plan with shorter waiting times.

6️⃣ Will It Work with Public Healthcare?

• Some insurers require you to go through the public system first before they pay out.
• If fast access to specialists is your goal, choose a plan that allows private care from the start.

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Red Flags to Watch Out For 🚩

❌ “Guaranteed Coverage” that excludes all pre-existing conditions – Might not help you.
❌ Hidden exclusions – Read the fine print to check for chronic illness-related restrictions.
❌ Low annual limits – If it only covers $1,000/year, it may not be worth the cost.
❌ Overly high excess – A cheap policy with a $5,000 excess isn’t helpful.

Photo by Photo By: Kaboompics.com on Pexels.com

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Making the Best Choice: A Step-By-Step Plan

✅ Step 1: List your key medical needs (specialists, medications, tests, etc.).
✅ Step 2: Compare insurance plans online (use Sorted NZ’s Insurance Tool).
✅ Step 3: Read the policy exclusions carefully.
✅ Step 4: Ask insurers directly if your condition will be covered.
✅ Step 5: Check for student, youth, or workplace discounts.
✅ Step 6: Choose the best balance of coverage & cost.

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Final Thoughts

📝 If your chronic illness won’t be covered, it may still be worth getting insurance for other health needs (like surgery, dental, or mental health).
💡 Look for insurers that offer ‘pre-existing condition reviews’ after 3 years.
📞 Always call the insurer and ask questions before signing up!

📎 Useful Links for Comparing Policies:

Consumer NZ – Health Insurance Reviews

Health Funds NZ – Industry guide to NZ health insurers

Sorted NZ – Insurance Guide – Compare policies and costs