Q&A webinars

Is Health Insurance Right for Me - Q&A Section

Apr 8, 2021 12:45:14 PM / by HealthCarePlus

Following on from last week's webinar we said that we would update everyone with answers to the questions we could not answer during the webinar itself

We received many questions so thank you for that and here as promised are the answers to the ones we were not able to talk to:


1. All have very busy life so when is the best time to buy health insurance?

That is a very good question and not necessarily an easy one to answer. It really depends on your own personal circumstances and what's important to you.  But in general, the answer would be a soon as you can and now is always to best time to buy health insurance. You are then covered if you health takes a turn and can speed up any treatment. If you wait until you get a medical condition and try buy health insurance you may find exclusions or loadings will apply.

We recently wrote a blog article on this subject, you can read it here: Do you need Health Insurance and when is the right time to buy it?


2. Does it cost more to go through an adviser?

Advisers are paid by the insurance company via commission so you do not have to pay for the advice you receive. Not all policies are the same quality though so it is important for you to get good advice.


3. The premiums are more than I spend on medical expenses each year. Can you speak to this? For example, When I had insurance in the USA, it was more reimbursement than 50%.

Under our 'day to day' plans are claims limits have been set at 50% to keep the premiums at an affordable level. Remember to claim your eligible expenses every year, some years you may have more claims than others. For the larger costs of surgery, or for life insurance and even insuring your house, insurance works by people pooling funds via premiums paid to ensure money is available if they need to make a really large claim. So the best case scenario for most of us is to never claim on those larger costs, but if we do, it is peace of mind to know we have a policy.


4. It makes it hard for me to justify

I guess nobody likes paying for insurance however it can take one claim and you will see the value of the cover. If you want peace of mind knowing you have access to quick health care it can provide this. It often comes down to personal views on health insurance or being happy to rely on the public health system.


5. Someone in my family has cancer, and I'm looking for a yearly cancer checkup for myself.

5.1  What is insurance for cancer checkups like ? does it cover all
major types of cancer, or do I have to specify what kind of cancer I want to be checked for.

Hospital Cover policies don't do surveillance checks solely based on family history. You must have symptoms to have any investigative testing done. Our day to day plan, Primary Care Extra does however offer cover for mole mapping around skin cancer / melanoma. Hospital Select also offers a contribution towards colonoscopy and gastroscopy every 24 months where 50% of costs are available up to the policy limits. Depending on the cancer the family member has, there are also programmes available with the public health system where you can get on a regular cycle for the likes of colonoscopies.

5.2 If a family member has cancer, does that count as pre-existing
condition ?

Every insurer will treat family history in a different way. Hospital Select does not consider family history. Other insurers do look at family history however if it is only one direct family member e.g. parents or siblings then no exclusions or loading would likely apply. If it is two family members with the same type of cancer then it may result in exclusions or loadings depending on their age. Click the button below to read more about our Hospital Select


6. If I use a Financial Advisor and I am not happy with his service, what avenues are available for me? who can help me to resolve my issues?

The first suggestion is to approach the Financial adviser yourself to try and resolve this issue. You need to give your financial service provider the opportunity to resolve your complaint with you. They will have a complaints process that they will follow and can provide you information of this. If you aren't happy with any resolution they offer they will belong to an independant complaints organisation that you can approach.


7. Is there a time limit for making a complaint about a financial advisor?

We are not aware of a time limit on complaints. You can search the Financial Services Provider register to find details of the adviser's disputes resolution scheme at this address: https://fsp-app.companiesoffice.govt.nz/ and can contact the scheme if you are unable to resolve your complaint directly with the adviser.


8. Is diabetes covered after 3 years period, if it is disclosed fully in the beginning?

Unfortunately any surgical costs related to Diabetes would be permanently excluded under the Hospital Select plan, however we do have another plan we could arrange which would provide cover for Diabetes after 3 years continuous cover.


9. If I take a health insurance and travel to my home country, can I make a claim if I get ill?

Yes you can, however you would need to return to NZ for medical treatment, although some medical insurance companies do provide some cover in Australia - if you are planning to travel the best option is to arrange travel insurance. Read more about our Travel Insurance offer below.


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10. The University of Auckland offers access to health insurance at a reduced rate. I have been trying to compare the policies of Southern Cross and HealthCarePlus on my own without much success. Is there a tool that can help compare the plans and the costs?

My suggestion would be to engage the HealthCarePlus representative in your area to seek advice and they will be able to help you. If you can provide them with the policy wording of the health insurance the University of Auckland offer.


11. Is it worth getting private health insurance for kids?

Absolutely, kids can also have major things go wrong with their health and it can speed up treatment. I know of a child where fundraising had to be done for a medication around cancer that wasn't covered. The right plan would have help the family out a lot. It also gives them future cover into their adult years if they have a plan now and something goes wrong with their health.


12. If I have existing condition, can I make a move to HealthCarePlus and continue to get all the conditions covered? How does it work?

It would depend on the health conditions you have. Certain pre-existing conditions may not be covered even after 3 years such as cancer, back or heart conditions or risk factors relating to them. If you have a current medical plan this may be best to keep if your pre-existing conditions are covered already. My suggestion is to seek advice from the HealthCare Plus representative in your area to assess your situation. 


13. HealthCare Plus plans seem to reimburse a maximum of 50% or up to a maximum amount. Is there a policy that covers perhaps 75% or 100% - for a piece of mind and convenience?

All policies on the market will have a maximum amount or percentage you can claim. Southern Cross have a plan for 75% of costs which cover 5 key areas for a total potential claim of $1,250. The cost for a 40 year old is 19/FN. A similar plan with HealthCare Plus is Primary Care Extra where 50% is covered however the potential claim is $2,000 and there are 10 key areas you can claim. The premium for a 40 year old is $11.72/FN for Primary Care Extra. 

You can take a look at the tables below at how we compare against the two main providers in the market with similar plans to our own.

PCX - benefits-1


14. Are there many, if any level premium plans available? If so, are they worth considering?

Unfortunately we are not aware of any level premiums for health insurance. However there are level premiums available for risk benefits such as life, trauma and income protection. They are certainly worth considering if you have a long term need for the benefits. My suggestion is to seek advice from a Financial Adviser who can guide you more on your needs.


15. Hi. Are non-pharmac drugs mostly applicable to cancer or a wider range of illnesses? For instance, what's the relative proportion of non pharmc drugs specifically for cancer from all non pharmacy drugs used in NZ? Thanks

We wouldn’t be able to give a definitive answer on any breakdown cancer vs non-cancer non-PHARMAC. We don’t have data on that. Potentially PHARMAC or the Ministry of Health may track that kind if info, unless it was on their website you would need to ask through an OIA request.

More specific to whether non-PHARMAC is cancer drugs or broader, it is broader. Prescription items can also be non-PHARMAC. MedSafe would have approved the drug for use in NZ, based on it’s safety, but PHARMAC doesn’t subsidise the drug.

As an example, a range of prescription drugs may be available around the world to treat a condition. MedSafe may approve a number of these for use. However, PHARMAC may only subsidise one of these for use. This helps them, and the NZ taxpayer, to purchase drugs under contract at a lower rate, because we’re buying 1x drug in bulk, as opposed to several drugs in low volumes without an agreement in place.

The other drugs can be used, as they are MedSafe approved, and will be prescribed in some instances. Instead of a pharmacy charging the $5, like they do for most PHARMAC approved prescriptions, the non-PHARMAC prescription may range in cost. Sometimes a person cannot tolerate the PHARMAC approved medication, whereas they will tolerate the non-PHARMAC version. Typically PHARMAC will look to purchase the most commonly available drug, or drug that would me most broadly tolerated, but it can come down to cost for them. Drugs have a timespan before other companies can make similar version of that drug, often at that time cheaper versions of the drug come to market, sometimes PHARMAC will then alter to the cheaper version. Then they can utilise that saving to purchase other drugs in other areas. It’s a very complex area, but this somewhat summarises it.


If you have more questions and would like to speak directly to our local HealthCarePlus advisers, please click the button below to book a chat with them.

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