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Buying health insurance if you have pre-existing conditions: It’s doable!

Can you get health insurance in NZ if you have a pre-existing condition? Learn how insurers handle pre-existing conditions, exclusions, and waiting periods.

7 min to read

By researching your options with the help of a Policywise adviser, you can get comprehensive health insurance or visitor medical insurance that covers pre-existing conditions.

This article explains what insurers regard as pre-existing conditions, what temporary and permanent exclusions and waiting periods are, and how to find the best medical cover for your health circumstances.

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What are pre-existing conditions?

A pre-existing condition refers to any medical condition or injury, or related sign, symptom, or health event that occurs or exists, diagnosed or not, before the start date of an insurance policy (or the start of an upgraded policy).

Even if you have not experienced symptoms or required treatment for many years, insurers may still regard any previous condition as pre-existing.

Some common pre-existing conditions include:  

  • Allergies
  • Asthma
  • Age-related degeneration
  • Cancer
  • Diabetes
  • Epilepsy
  • Heart diseases
  • Hypertension/high blood pressure
  • Mental health conditions, such as anxiety and depression
  • Osteoporosis
  • Sleep apnea
  • Past injuries, surgeries, and illnesses even if you’re already in the clear.

Note that having pre-existing conditions doesn’t mean you can’t get cover at all, or that these health issues will be automatically excluded from your policy. Health insurers may cover some pre-existing conditions if you meet specific criteria. Others may set a waiting period or adjust your premium to cover your existing conditions.

It's important to fully disclose your pre-existing medical conditions when applying for health insurance to ensure that your policy accurately reflects your health status. Consult a Policywise adviser for guidance in finding the optimal plan that works with your pre-existing conditions and provides the cover you need.

Can you get health insurance with a pre-existing condition? 

Health insurers may offer you good cover but with certain terms and conditions. They can:

1. permanently exclude specific conditions from your policy. This can mean no cover for doctor’s visits, tests, and treatments related to the excluded condition. Depending on your insurer and policy, the following pre-existing health issues may be permanently excluded:

  • Congenital conditions (some insurers may provide limited cover for specific congenital conditions or cover issues not diagnosed within the first months of life)  
  • Acquired cardiovascular conditions or cardiovascular conditions combined with specific risk factors
  • Cancers (some plans may cover pre-malignant, pre-existing cancers under certain conditions)
  • Hip or knee degenerative conditions, diseases or injuries
  • Back conditions or injuries
  • Transplant surgery
  • Reconstructive or reparative surgery.

2. charge a (reasonably) higher premium to include certain conditions

3. impose waiting periods (typically ranging from 12 months to a few years) before covering a condition. For example, your insurer will only start paying claims related to your pre-existing condition after you’ve had cover with them for 3 consecutive years. 

Discuss your full medical history with a Policywise adviser to clearly understand what conditions or treatments may be partially or fully excluded before purchasing a policy. Policywise can help you find the best insurance plan for your needs and avoid any potential issues with future claims.

 

What if I find out about a pre-existing condition after taking out health cover? 

Insurers differ in how they define pre-existing conditions and whether or not your knowledge of a health issue will impact future claims. It’s best to contact your insurance adviser to discuss your policy wording as soon as you learn about your condition.

Can you change health insurance providers or plans with pre-existing conditions? 

While you can change health insurers or switch plans, you need to consider how it may affect your cover for existing medical issues.

Medical conditions developed after taking out your new policy are generally covered. If you switch to a new insurer or plan, your current medical issues may be considered pre-existing conditions and subject to exclusions, waiting periods, or a higher premium.

Tips for getting the best medical cover if you have existing health issues

Several major health insurance providers in New Zealand offer cover for pre-existing conditions but may impose limitations. Here are some tips to keep in mind when applying:

  • Disclose your medical history upfront - failing to mention a health issue may mean the insurer will deny future claims.
  • Inquire about the possibility of getting cover for your pre-existing conditions.
  • Consider starting with a health insurance policy which excludes your pre-existing conditions but covers everything else.  When your health issues are resolved, request to have these exclusions lifted.
  • Look into group health insurance plans, through an employer or association, that may offer better terms.
  • Work with an insurance broker, such as Policywise, to compare plans from the best health insurers and negotiate with them on your behalf.
  • Keep your existing cover while applying for a new policy, as gaps can reset exclusion periods.
  • Read your policy and membership certificate, and ask questions about your insurer’s definition of pre-existing conditions, what’s covered, and what’s excluded.
  • Ask about reducing stand-down periods or getting exclusions reviewed if you've been symptom and treatment-free for many years.

How can Policywise help?

Policywise can provide more information about pre-existing conditions and help you find and compare the best covers for your health circumstances. Our insurance advisers can also negotiate with insurers to get you good medical cover, and assist you during claim time.

Policywise is a 100% free service which tells you which health and life insurance plans best fit those with pre-existing conditions. We offer fast, comprehensive, and easy-to-understand comparisons of all leading providers, and a simple summary recommending which insurer is right for your situation.

Not all insurance policies are the same. Policywise can help you sort out the duds, avoid the lemons, understand the fine print and exclusions, and get the right insurance for you and your family.

We make the important decision of where to buy your insurance super easy. We’ll answer your questions, provide experienced advice, quotes, and comparisons, and manage all the back and forth throughout the application process. Taking out your cover through us means you'll have our lifetime support and claims advocacy. We can also take care of lodging any claims on your behalf and back you up if the going gets tough.

Check out the reviews on our homepage for how other New Zealanders have found our service because now is the time to get your health insurance sorted. Give your family or someone you love the most outstanding financial support possible. Book a 5-minute callback with Policywise today; our service is fast and free.

All information on this page or website is general information only, not intended as advice, and does not take into consideration your personal circumstances. We recommend consulting a Policywise adviser before making any insurance decision.

Please note: Policywise advisers are licensed by the Financial Markets Authority to provide financial advice in relation to health insurance, life insurance, and disability insurance. You can learn more about this on our Public Disclosure page. All insurance covers are subject to the insurer’s approval of your application.

Insurance policies and their built-in and optional benefits may be subject to stand-down periods, exclusions, terms and conditions, and premium loadings not listed on this website. Optional benefits also have additional premiums. Please refer to the insurance product’s policy document for full details. Insurers may alter these details at any time.

Therefore, nothing in our product pages is intended to be definitive or binding. Where there are discrepancies between any policy wording on this website and the policy wording provided by the insurance company at the time your cover is approved, then the insurance company’s wording will be deemed the correct version.

Quickly find the cover that’s best for you

Policywise tells you which health, life or disability insurance best matches your circumstances, 100% free. Talk to one of our insurance advisers to find out which health or life insurance is best for you.

References

Accuro Health Insurance. (n.d.). General questions. Retrieved 12/11/2024 https://www.accuro.co.nz/faq/general-questions/

Accuro Health Insurance. (2024, June). SmartCare+. Retrieved 12/11/2024 https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/June-2024-Policy-Docs/SmartCare%2B-June-2024.pdf

AIA. (2024, March 8). AIA Private Health. Retrieved 12/11/2024 https://www.aia.co.nz/content/dam/nz/en/docs/our-products/policy-wordings/health/aia-private-health-umbrella-policy-wording.pdf

Asteron Life. (2017, October 25). Insurance options for pre-existing conditions. Retrieved 12/11/2024 https://www.asteronlife.co.nz/blog/insurance-options-for-preexisting-conditions.html

Health and Disability Commissioner. (n.d.). Code of health and disability services consumers' rights. Retrieved 26/01/2024 https://www.hdc.org.nz/your-rights/about-the-code/code-of-health-and-disability-services-consumers-rights/

Insurance & Financial Services Ombudsman. (2024). Pre-existing medical conditions. Retrieved 13/11/2024 https://s3.ap-southeast-2.amazonaws.com/ifso-files/docs/Pre-existing-medical-conditions.pdf

Insurance & Financial Services Ombudsman Scheme. (n.d.). Health insurance. Retrieved 12/11/2024 https://www.ifso.nz/information/health-insurance

nib. (2024, April 16). Pre-existing conditions health insurance. Retrieved 12/11/2024 https://www.nib.co.nz/free-resources/article/health-insurance-pre-existing-conditions-we-choose-fairness-not-fear

nib. (2023). Premium Hospital policy document. Retrieved 12/11/2024 https://assets.ctfassets.net/ja9v5o5o08yv/6u2VuzNkNG0Jc0Niqbrp57/64250333828523da96b4965de250bb7e/Premium_Hospital_Policy_Document__effective_for_new_policies_or_policies_renewing_from_1_February_2024_or_later_.pdf

nib. (2023). Standard Hospital policy document. Retrieved 12/11/2024 https://assets.ctfassets.net/ja9v5o5o08yv/2MB3LvJjtmTr8K1lKpLUBD/70cf7de0f5dc7dfd8423baab450842ce/Standard_Hospital_Policy_Document__effective_for_new_policies_or_policies_renewing_from_1_February_2024_or_later_.pdf

nib. (2023). Ultimate Health policy document. Retrieved 12/11/2024 https://assets.ctfassets.net/ja9v5o5o08yv/z7NkWDogU7CB3IkWc7GU7/518c2505105870a368a77d2455dea946/Ultimate_Health_Base_Policy_Document__effective_for_new_policies_or_policies_renewing_from_1_February_2024_or_later_.pdf

Partners Life. (2021, June 1). What are exclusions and restrictions? Retrieved 13/11/2024 https://www.partnerslife.co.nz/news-and-views/what-are-exclusions-and-restrictions

Shine Lawyers. (n.d.). Pre-existing medical conditions and health insurance – a guide. Retrieved 13/11/2024 https://www.shinelawyers.co.nz/blog/insurance-law/pre-existing-medical-conditions-and-health-insurance/

Southern Cross Health Insurance. (n.d.). Review your pre-existing condition(s). Retrieved 13/11/2024 https://www.southerncross.co.nz/society/for-members/managing-your-policy/pec-review

Southern Cross Health Insurance. (n.d.). UltraCare policy document effective from 22 October 2024. Retrieved 12/11/2024 https://mc-fec8b19f-c7fd-4e56-8bfe-1850-cdn-endpoint.azureedge.net/society/-/media/southern-cross-health-society/health-insurance/member-collateral/plan-documents/current-plan-documents/pd_ultracare_plan.pdf?rev=64728477f09b41ebaed421dd586a673b&hash=CF8658B83FFEB90B09EDD1F908FB0A62

Southern Cross Health Insurance. (n.d.). Wellbeing One and Two policy document effective from 22 October 2024. Retrieved 12/11/2024 https://mc-fec8b19f-c7fd-4e56-8bfe-1850-cdn-endpoint.azureedge.net/society/-/media/southern-cross-health-society/health-insurance/member-collateral/plan-documents/current-plan-documents/pd_wellbeing_plan.pdf?rev=5f4ccc41c0c041188d56324549540876&hash=ADB255E6C5EB46C55E6568D196388C7B

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