Health insurance is complex. Understanding health insurance can be a daunting task, never mind reading through pages of policy documentation that is full of insurance terms. We have made a directory to simplify what it all means.
It only takes a few minutes to read, but hopefully it will ensure you understand the information you need to make an informed choice about what insurance is right for you now and in the future .
So What is Medical Insurance?
It's a generic term that could refer to 3 levels of insurance:
- Day to day plans provide reimbursements for everyday medical expenses e.g. 50% of GP costs under our Primary Care Extra plan
- Surgical Plans which cover costs of medically necessary surgery or treatment in a private hospital, can include an add-on benefit for specialist & test expenses e.g. our Hospital Select plan
- Comprehensive medical plans which include both of the above
Definitions:
| Benefit Maximum or Entitlement | The maximum, total (or aggregate) sum that will be reimbursed for the specified period relating to the health care services or benefit outlined in the Benefit Section. Note: in some cases Sub-limits will apply. |
Sub-limit
|
This is a limit that applies to a specific health care service or benefit within a Benefit Section. For example a prescription limit of $20 per item. |
| Pre-Existing Medical Conditions | Any sign, symptom, treatment, surgery, illness, injury or event either diagnosed or that should have been diagnosed, that has occurred during your lifetime prior to applying for new insurance cover that you would reasonably be expected to be aware of. |
Full Disclosure |
That you have told the insurance company everything that you could reasonably be aware of in relation to your application for insurance |
Underwriting |
Underwriting is the process insurance companies go through when evaluating the risk of insuring a person/s, including things such as; health conditions, occupation and smoking status get taken into consideration during the underwriting process. The types of issues that are included will depend on the type of insurance that is being applied for |
Exclusion |
A medical condition that an insurance company specifically states on your policy where they will not pay a claim |
Premium/Subscription |
The amount of money you need to pay the insurance company for your policy |
Premium Loadings |
The additional cost over and above the standard cost an ‘average’ person would pay, if the insurance company thinks your specific health, occupational or pastimes could pose a greater likelihood of claims |
Excess |
An amount you elect when you take out your policy, that you will personally pay towards any medical claim i.e. the insurer will pay the claim less the amount you have chosen for your excess up to the maximum amount stated e.g. $300,000 per event. |
Renewal |
Your policy is renewed annually. All of our day to day "Primary Care" Plans renew on the 1st January each year and for our other Plans from the date your policy was put in place. The renewal will happen automatically on an annual basis. |
Guaranteed Terms |
Some insurance companies ‘guarantee’ that they cannot alter the terms of your insurance policy after it has been issued, in any way that might be detrimental to you. This means that the premiums can change along with changes to your age but the terms and conditions of the policy cannot be changed and the policy can only be cancelled by you the policy holder and not the insurer |
Prior approval |
Prior to having surgery or treatment you need to get the insurance company to agree that they approve the estimated costs and treatment provider. Once approved and following your treatment the insurer will pay the treatment provider directly less your chosen excess |
Medsafe |
A division of the Ministry of Health which is responsible for regulation of medication and treatment in NZ |
Pharmac |
A government entity responsible for approving government funding of medication & treatments in NZ |
Non Pharmac |
Medications and treatments that have not been approved for government funding in NZ |
Waiting Period |
This is the minimum period that all Members on a policy must have been continuously insured (with premiums fully paid) before they are eligible to claim. |
Hopefully we have cleared up some of the confusion and you found this list is useful.
If you come across any other terms related to your health insurance that you want clarified then please let us know by leaving a comment below and will provide you with a definition.
