BIG Plans Admin May 24, 2015 No Comments

Questions you should ask your Health Insurance provider


Health Insurance may be seen as a luxury more than a necessity, but according to more than 32% of New Zealanders have private health insurance.  I think this is considerably high, especially if most of us see it as a luxury.  Maybe now, it is no longer a luxury but fast becoming an important part of preserving our quality of life.

Why we do we have Health Insurance?

Everyone will have their own reasons.  Maybe it’s the thought of being on a waiting list to get surgery or not getting that personal level of attention (and privacy) you may want.

The thought of not being able to do what we want to until we get our treatment can be daunting to us, especially since we are nation who enjoys the outdoors and lead a more active outdoor life.

Or maybe we want to know that we can get things sorted and back to work as soon as possible because the financial implications will affect your family and job performance.

Whatever your reason, ultimately it comes down to peace of mind and that sense of security knowing that you will get private treatment whenever you need it.

So what happens at claim time?

This is where your insurer can really shine or rain on your parade, depending on how well you understand your cover.  This is where the policy wording makes all the difference and it does not matter what the company said on the phone, or your adviser said to you.

What matters is what your policy wording says…and that’s it.

In my experience, whenever there is bad publicity around insurers not paying claims and very unhappy clients, I believe it is a case of over expectation from the client and under deliver from the insurer.  When expectation and delivery don’t match up, that’s when problems occur.

Here are some questions you should ask your Health Insurance provider

Ideally you should ask your health insurance provider or broker before you take your policy out, or if you have health insurance already, then there is no reason why you cannot still ask them.

Q: Is my policy guaranteed renewable

You should make sure that your health insurance is guaranteed renewable, for so long as you are prepared to pay the premium.

Q: Does my insurer reserve the right to impose special terms and conditions and get your to accept them before they renew your policy

You need to make sure that your insurer cannot impose special conditions on the annual anniversary of your health insurance policy.  For example, if you have been having a number of claims for a particular condition, your insurer may choose to exclude that condition and ask you to accept an exclusion for that condition on the annual anniversary of your policy.  Of course this is no good for you, because that’s the reason you have your own private cover?…right?

Q: Do I have excess options to offset premium increases as I get older

Make sure you have an option to pay an excess to reduce your premiums if they get too expensive.  It is a fact of life that when we get older, the likelihood of claiming is greater and therefore premiums get higher.  So if you have a way to try and manage some of the premium increases by choosing to pay the first $X amount of dollars, this may help keep premiums affordable for you as you get older.

Q: Do they pay for non Pharmac subsidised drug treatment

This is more personal for me.  Pharmac are the New Zealand agency who subsidises drug treatment costs and some insurers will not pay for drug treatment if the drug is not Pharmac subsidised.  Some time ago Herceptin was being used to treat breast cancer and the drug was achieving great results but Herceptin was not being subsidised by Pharmac, therefore health insurers were not paying for the treatment.

It took a number of years for Pharmac to subsidise Herceptin but in the meantime, unless you had an insurer who would pay for this then you had to raise your own funds.

Needless to say Herceptin is now subsidised by Pharmac but there are new drugs being developed and I think it is important to have an insurer who will pay for new drug treatment whether Pharmac subsidise it or not.

These are very important questions because at claim time, you cannot change your policy wording.

Also, if you have a claim, this most likely means you have a medical condition, so therefore you will need to stay with them because any new health insurer will normally exclude any pre-existing conditions.