#4 What you need to consider

Insurance 101-Things to consider-Health Insurance

Health Insurance

Does the insurer automatically exclude all “pre-existing conditions”, which means that any personal illness or injury condition that was known and existed prior to signing of an insurance application cannot be claimed on?

Alternatively, do they fully scrutinise your medical past before deciding on what they cannot cover, based on what you have disclosed and/or from your medical records?

What are the limitations for Surgical Hospitalisation, that is, general surgery, cardiac surgery, oral surgery, etc?

Some will cover as much as $200,000 per person per claim, others may limit cover to $100,000 per operation and some will only pay up to 80% of certain procedures.

Not all claims involve invasive surgery and today more and more treatments are performed by non-surgical procedures. What are these limits and restrictions?

What about being covered for Specialists’ consultations (like Oncologist, Obstetrician, Osteopath, etc.) and major diagnostic/imaging procedures (like Mammograms, Ultrasounds, CT and MRI scans, etc)? Are these costs regarded as being part of a surgical hospitalisation claim? If not, do you want cover for this as it will cost you an additional premium?

There may be times when your spouse wants or needs to be with you for an out of town procedure. Is there cover for travel, including accommodation for a support person?

Sometimes the surgery required can only be performed overseas, so is this treatment be funded under your policy?

Because of the huge costs of some new drugs, these are commonly not on the PHARMAC List – this is the list of drugs not provided free within NZ. Will your policy refund the costs of those drugs not on this List?

Similar to Trauma insurance, can your insurer automatically change the policy wording after you have received it? Some policy documents allow alterations to include new surgical and medical procedures. Premiums for these policies are likely to increase faster than those policies that cannot be changed.

Can you control the cost of increasing premiums by agreeing to pay a defined amount (called an Excess) towards any claim. What are the choices available (e.g. $250, $500, $1,000, $5,000 or even $10,000) and what effect does this have on your premium?