Understanding exactly what private health insurance covers in New Zealand can be confusing. Policies vary significantly between providers and plan levels. Here's a plain-English breakdown.
What's Typically Covered
Planned surgery: This is the core benefit of most NZ health insurance policies. Cover includes the surgeon's fee, anaesthetist, private hospital room, and related nursing care.
Specialist consultations: Visits to private specialists including physicians, surgeons, and other consultants. Often requires a GP referral.
Diagnostic tests: Private MRI, CT, PET scans, X-rays, blood tests, and other investigations. Getting these done privately means faster results.
Cancer treatment: Most hospital policies include cover for cancer treatment, including chemotherapy and radiation. Premium policies add non-Pharmac drug coverage.
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Physiotherapy and rehabilitation: Many policies cover post-surgical physiotherapy and rehabilitation.
What's Typically Not Covered
ACC-covered injuries: If your condition is covered by ACC (Accident Compensation Corporation), your private health insurance won't pay out — ACC pays instead.
Cosmetic procedures: Elective cosmetic surgery is generally excluded unless it's for medical reasons (e.g., reconstructive surgery after cancer).
Dental and optical: Basic dental and optical are excluded from hospital policies. You need a day-to-day policy to cover these.
Pre-existing conditions: Conditions you had before taking out insurance may be excluded or have longer waiting periods.
Emergency presentations: Public hospital emergency departments are not generally covered — your public ACC or DHB cover applies.
The Difference Between Policy Levels
Basic hospital: Covers planned surgery and hospital stays. Most cost-effective starting point.
Comprehensive: Adds specialists, diagnostics, and sometimes day-to-day cover. Higher premiums but broader protection.
Premium: Adds non-Pharmac drugs, international cover, and enhanced benefits. Highest premiums but most complete protection.