Jones MarciaWhat matters most is the fine print of the policy. Basic health insurance should include the following:
- Surgical coverage – for example, surgical treatment for acute illnesses such as cancer;
- Non-surgical coverage – for example, allergy treatment;
- Basic diagnostic tests – covering procedures such as biopsies and mammograms;
- Non-pharmacy coverage – coverage for medicines that are not subsidized by Pharmac (essentially the New Zealand government) for specialty medicines you may need;
- Overseas treatment – coverage if the treatment you need cannot be done in New Zealand (although this is rare).
Your individual needs will help you decide how much cover you need. It is pointless to have GP visits covered if you rarely see a doctor and/or cannot afford it, but at the same time not having enough cover can create stress for you and your family later if your cover is not enough to pay for the treatment you need.
Understanding health insurance exclusions
To help you understand what’s most important, we explain what’s “not covered” and “exclusions” and what the difference is.
- Most policies do not cover specific standard treatments such as dental care and physiotherapy – these are known as “not covered”. Below are a few examples, but it is important to check the policy you are purchasing to find out exactly what is not covered. Standard treatments that fall under “not covered” are different from “exclusions”;
- “Exclusions” are claims for medical treatment related to or caused by certain diseases or conditions that are not covered by your health insurance. Examples of exclusions include claims for dementia care, pregnancy complications, and organ transplants.
Examples of items that (usually) fall under “not covered” (unless your policy specifically allows it):
- Consultations with a general practitioner;
- Dental care;
- Optical care (i.e. contact lenses and/or glasses);
- Related treatment, such as physiotherapy, chiropractic care or osteopathy;
- Acupuncture, traditional Chinese medicine and therapeutic massage;
- Speech therapy;
- Any mental health treatment.
Examples of items that (usually) fall under the “exclusions”:
- Chronic diseases;
- Cosmetic care / procedures;
- Dementia;
- Fat transplantation and liposuction;
- Sex reassignment surgery;
- HIV/AIDS and any medical condition resulting from it;
- Infertility or assisted reproduction (IVF);
- Disease caused or contributed to by drug or substance abuse;
- Organ transplantation, transfusion of autologous blood/blood products;
- Self-inflicted illness or injury;
- Unapproved medical services.
