Health Insurance

Health insurance, how does it work and when you would need it.  This article will explain what it is, how it works and some examples where you would be glad you had it.

This is private insurance where you pay a small premium to the insurer, and they will pay for the big private medical costs outlined in their policy document.  What types of costs insurers pay for and how much they pay can be very different from each other, which is why you should always talk to us first.

One of the more popular form of Health Insurance is hospital cover, which is generally blanket cover that will pay for all surgical and non surgical treatment in a private hospital up to the policy maximum per year.  It’s a simple product to understand because it does not have a complex scheduled of limits within the policy that some other health insurance policies can have.

Depending on your insurer, you may also have the option of paying an excess to reduce your premium.  Just like vehicle insurance, the higher the excess you are prepared to pay, the cheaper your premium will be.  Having an excess option is very important because as you get older, you can increase your excess to offset some of the premium increases as you get older.

Hospital types of cover are not strictly limited to hospital, because some of them will pay for specialists treatment, drug treatment, diagnostic procedures and a range of other types of benefits, so although it may seem simple, the cover you get can be very comprehensive.

Most insurers will have optional add-ons to enhance your cover as well, but that is up to you, your priorities and of course, budget.

Schedule of Limits for Health Insurance

If you currently have health insurance, you may want to check to see whether your current cover has a schedule of limits.  This is where some people can get caught and end up paying more money at claim time then they expect.  A schedule of limits is like a itemised breakdown of costs covered under the procedure you need and the maximum an insurer will pay for that cost, and if the cost is over the maximum limit you will need to pay the difference.

For example, let’s say your insurer will pay up to $20,000 for a hip operation, but within that $20,000 they may have a maximum limit of $3,000 for an anaesthetist.  If the anaesthetist cost ends up at $4,000 you will need to pay the difference, which in this example would be $1,000.

Why have Private Insurance

Waiting lists! According to the Health Funds Association, the average to surgery time from a GP visit is 177 Days for Public System and only 76 Days for Private.  Most of us know someone who has been on a waiting list only to be pushed back, or the criteria changes and they don’t qualify at all.  Let’s not forget the innovative drug treatments that are available and approved by MedSafe but not subsidised by PHARMAC.

In 2015 private insurers paid in excess of $1 Billion NZD in private health insurance claims, and it’s only going to get higher.  To get the medical treatment you need it most, contact us to talk about your cover and premium options.

health insurance