Medical Cover

Medical insurance can include cover for G.P. visits and prescriptions. However, it is more common for most applicants to take out only hospital and surgical cover, and then choose to self insure for the cost of prescriptions and G.P. visits.

Children may be added to their parents policies, and normally after the child attains the age of 20 or 21 (depending on individual company preferences), a child is normally required to be issued with a stand alone contract in their own right, and will be removed from their parents contract.

The basic hospital and surgical provides cover for surgeons costs, anaesthetists and other attending specialists, and the hospital accommodation charges.

The level of reimbursement will vary from policy to policy, depending on the individual contract wordings, but is usually in excess of 95% of the costs incurred.

The basis for hospital/surgical cover is that one needs to undergo a surgical procedure before a claim can be initiated. Accordingly, many people these days add on a specialists and tests benefit option, which provides them cover for specialist consultations and diagnostic tests i.e. xrays, MRI scans, endoscopies, colonoscopies, etc where a surgical procedure may not automatically follow, and therefore these costs may not be included under a base hospital/surgical contract.

Hospital/Surgical cover is normally only applicable in New Zealand, and to provide cover while one is travelling or living overseas you should take out travel insurance, or some other hospital/insurance plan, domiciled in the country of residence.

You should also be aware that in the event of an accident, ACC will probably become involved. Your claim under a surgical contract may be subject to involvement of ACC over the level of compensation being paid, and whether or not ACC will approve of your chosen specialist, the cost they intend to charge for their surgical procedures and the location and timing in which this procedure is to take place. Normally the medical insurance company will not be able to finalise your claim until these issues have been resolved with ACC.