Medical Insurance

Medical Insurance and Specialists and tests to have the best medical/hospital attention…

Health or medical insurance in New Zealand provides individuals with an additional layer of coverage beyond the public health system, offering a range of benefits for various healthcare needs. Here’s an introduction to health insurance in New Zealand, outlining key aspects and comparing it to the public health system:

  1. Comprehensive Coverage:

    • Health Insurance: Private health insurance in New Zealand provides comprehensive coverage for a variety of healthcare services, including hospital stays, surgical procedures, investigations, specialists’ consultations, diagnostic tests, and non-pharmac drug treatments.
    • Public Health System: New Zealand’s public health system, funded through taxation, also offers a broad range of healthcare services, but the coverage may be limited for certain non-urgent treatments and elective procedures.
  2. Hospital and Surgical Coverage:

    • Health Insurance: Private health insurance ensures coverage for private hospital stays, elective surgeries, and associated medical expenses. This often results in faster access to elective procedures and a choice of specialists.
    • Public Health System: The public health system covers hospital stays and necessary surgeries, but elective procedures may be subject to waiting lists and availability.
  3. Specialists and Consultations:

    • Health Insurance: Individuals with health insurance have the flexibility to choose specialists with the need for a referral, allowing for quicker consultations and personalized healthcare.
    • Public Health System: While the public health system provides access to specialists, referrals from primary care providers are usually required, and wait times may vary.
  4. Diagnostic Tests and Investigations:

    • Health Insurance: Private health insurance often covers a wide range of diagnostic tests, investigations, and imaging procedures, ensuring prompt access to necessary medical diagnostics.
    • Public Health System: Diagnostic tests are available in the public health system, but wait times may be longer for non-urgent cases.
  5. Non-Pharmac Drug Treatments:

    • Health Insurance: Some health insurance policies cover non-pharmac approved drug treatments, such as targeted therapies, immunotherapies, or other specialized medications that may not be fully funded by the public health system.
    • Public Health System: The public health system provides access to essential pharmaceuticals, but coverage for specific non-pharmacological treatments may be limited or not available at all.
  6. Choice of Providers:

    • Health Insurance: With health insurance, individuals often have the freedom to choose their healthcare providers, including hospitals, specialists, and other healthcare professionals.
    • Public Health System: In the public health system, individuals may be assigned to specific providers based on availability and geographic location.
  7. Costs and Premiums:

    • Health Insurance: While private health insurance comes with premiums, it provides the flexibility to customize coverage, reducing out-of-pocket expenses for healthcare services.
    • Public Health System: The public health system is funded through taxation, providing free or subsidized healthcare services, but some costs, such as prescription fees, may still apply.
  8. Waiting Times:

    • Health Insurance: Private health insurance typically offers shorter waiting times for elective procedures and consultations.
    • Public Health System: Wait times in the public health system can vary, especially for non-urgent treatments and elective surgeries.

Ultimately, the choice between private health insurance, self funding, and the public health system in New Zealand depends on individual preferences, healthcare needs, and budget considerations. Health insurance provides an additional layer of flexibility, choice, and expedited access to healthcare services for those who prioritize these factors. Individuals are encouraged to carefully review policy details, compare coverage options, and consider their unique healthcare requirements when making decisions about health insurance in New Zealand.

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Everyday type medical coverage

In New Zealand, the decision to include or exclude coverage for general practitioner (GP) visits, optical, and dental care in insurance plans can vary based on the type of insurance and the specific policy. Here’s a general overview of each:

  1. GP Visits:

    • Covered: Some health insurance plans in New Zealand may cover GP visits, especially if the coverage includes outpatient services. This can help offset the costs of routine doctor visits, consultations, and preventive care.
    • Not Covered: Other plans may exclude GP visits and focus more on major medical expenses or hospitalisation.
  2. Optical Care:

    • Covered: Some health insurance plans provide coverage for optical care, including eye examinations, prescription glasses, and contact lenses.
    • Not Covered: Not all plans include optical coverage, and individuals may need to purchase standalone vision insurance for such needs.
  3. Dental Care:

    • Covered: Dental insurance plans specifically designed for dental care are available and cover services such as routine check-ups, cleanings, and dental procedures.
    • Not Covered: Many general health insurance plans may not automatically include dental coverage, and individuals may need to purchase separate dental insurance or rely on out-of-pocket payments for dental expenses.

It’s important for individuals to carefully review the details of their insurance policies to understand what is covered and what is excluded. Some policies may offer optional add-ons or riders for additional coverage, allowing individuals to customize their insurance plans based on their specific needs.

Moreover, public healthcare in New Zealand, provided by the District Health Boards (DHBs), covers certain medical services, but individuals may choose to complement this with private health insurance for additional benefits and faster access to services.

Before choosing a health insurance plan, it’s advisable to compare different policies, consider individual healthcare needs, and consult with insurance advisors to make an informed decision based on personal circumstances.


  1. Selective Medical Insurance Coverage:

    • Consider having medical insurance without “specialists and tests” coverage to manage costs.
    • Review and adjust your coverage over time based on your budget.
  2. Higher Excess Options:

    • Opt for higher excess options on your medical cover to reduce premium payments.
    • Building a personal medical fund can justify taking higher excesses.
  3. Critical Illness and Medication Coverage:

    • Look into medical insurance that aligns with Pharmac/Medsafe rules in New Zealand.
    • Some insurers may cover drug treatments approved by Medsafe, even if not subsidized by Pharmac.
    • This can provide more options for major illnesses like cancer.

Additional considerations:

  • Regularly Review Coverage: Periodically reassess your insurance needs and coverage to ensure they align with your current situation and budget.

  • Emergency Fund: In addition to medical insurance, consider building an emergency fund to cover unexpected medical expenses.

  • Wellness Programs: Some insurance plans offer wellness programs or discounts that can help prevent health issues, potentially reducing long-term medical costs.

  • Compare Plans: Explore different insurance providers and plans to find the one that best suits your needs and offers the most value for your money.

  • Seek Professional Advice: Consult with insurance advisors or financial experts to get personalised advice based on your specific circumstances.

Remember that maintaining good health through a balanced lifestyle and regular check-ups is crucial in preventing major health issues. These practices, combined with thoughtful insurance planning, can contribute to both your financial and physical well-being.

Contemplating if to have cover for GP’s, Optical, Dental Care.

In New Zealand, the decision to opt for insurance coverage or self-insure for GP visits, optical, and dental care depends on individual preferences, financial circumstances, and the perceived value of insurance. Here are some factors to consider for each option:

1. Insurance Coverage:

  • Advantages:

    • Financial Protection: Insurance provides a level of financial protection by covering a portion of the costs associated with GP visits, optical, and dental care.
    • Predictable Costs: With insurance, individuals can have more predictable and manageable healthcare costs through regular premium payments.
  • Considerations:

    • Premium Costs: Individuals should assess the cost of insurance premiums against the potential benefits and their healthcare needs.
    • Policy Limitations: Examine the specifics of insurance policies, including coverage limits, waiting periods, and any exclusions.

2. Self-Insuring with Own Cashflow:

  • Advantages:

    • Flexibility: Self-insuring allows for flexibility in choosing healthcare providers and services based on personal preferences.
    • Savings Potential: If an individual has the financial means, self-insuring can involve setting aside funds in a dedicated account to cover healthcare expenses.
  • Considerations:

    • Financial Capacity: Assess whether there is enough financial capacity to comfortably cover unexpected or significant medical expenses.
    • Emergency Fund: Having a robust emergency fund is essential for self-insuring, ensuring there are sufficient funds available when needed.

3. Combination Approach:

  • Advantages:

    • Balanced Approach: Some individuals opt for a combination of insurance coverage for major expenses and self-insurance for routine or less expensive healthcare needs.
    • Tailored Solutions: This approach allows for a more customised healthcare strategy based on individual circumstances.
  • Considerations:

    • Coverage Gaps: Evaluate potential gaps in coverage and ensure that self-insurance adequately addresses those gaps.
    • Regular Review: Regularly review insurance policies and financial circumstances to make adjustments as needed.

Ultimately, the decision between insurance coverage and self-insuring depends on personal risk tolerance, financial goals, and the desire for financial protection. Individuals should carefully assess their own situation, consider various scenarios, and seek advice from financial professionals if needed to make informed choices regarding healthcare financing.

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