Ultimate Health and Ultimate Health Max are our two most comprehensive covers, offering complete choice and flexibility for you and your family.
Both products start with the Base Cover, which provides cover for the big expenses like surgical, medical (non-surgical) and cancer treatment in a private hospital. Ultimate Health Max has the additional benefit of cover for Medsafe approved drugs that are not subsidised through PHARMAC for treatment at home and in a private hospital.
The wording for Ultimate Health Max is guaranteed, this provides you with the added security of knowing exactly what you are covered for when it is time to claim. Additionally, any favourable future changes to Ultimate Health Max will automatically be applied – such as the inclusion of new benefits and an increase in benefit limits.
To find out more, contact your financial adviser or click 'find an adviser' and we will put you in touch with someone who can help.
Covered conditions under this plan
Ultimate Health™ and Ultimate Health Max™ provide coverage for all the conditions in the table below, provided the treatment is covered by one of the benefits on the policy. The policy documents for both products are available below under Insurance documents.
All ACC top-up claims
Hernia, appendix
Anus, haemorrhoids
Oral (excluding orthognathic surgeries)
Unerupted and impacted teeth
Sinus, nose, ears
Ankle, elbow
Circumcision
Tonsils, grommets, adenoids
Skin lesion – GP
Skin lesion – specialist
Digestive tract, liver, kidney, pancreas, gall bladder
Breast, gynaecology, urology
Cancer surgeries and treatment
Shoulder, wrist
Varicose veins
Brain, eyes, neck
Gland, vascular
Chest, back
Foot, toe, hands, fingers and thumbs
Non-surgical hospitalisation
Benefits of Ultimate Health™ and Ultimate Health Max™
These benefits apply to the conditions covered by Ultimate Health™ and Ultimate Health Max™ (click on 'Covered conditions')
All benefit limits apply to each person on the policy (just in case you thought you'd have to share!)
Note: this is not the policy document. For all the legal bits, see the Ultimate Health™ and Ultimate Health Max™ policy document under 'insurance documents'.
Surgery
Surgery in a recognised private hospital.
Includes costs for:
- Surgeon's operating fees
- Anaesthetist's fees
- Intensivist's fees
- Hospital accommodation (e.g. the admitted patient's bed, a private room, excludes suites)
- Operating theatre fees
- Surgically implanted prosthesis (in line with the prosthesis schedule)
- Laparoscopic disposable
- In-hospital X-ray examination and ECG
- Intensive post-operative care and special in-hospital nursing
- In-hospital post-operative physiotherapy
- Ancillary hospital charges (e.g. dressings, sutures, needles, bandages)
- In-hospital pharmaceutical prescriptions (in line with the PHARMAC Pharmaceutical Schedule A to H; Ultimate Health Max only: also includes non-PHARMAC drugs approved by Medsafe)
Oral surgery
Dental surgery in a recognised private hospital performed by a registered oral surgeon or maxillo-facial surgeon.
We will cover for removal of unerupted and impacted teeth (e.g. wisdom teeth) if a registered oral surgeon, dentist or maxillo-facial surgeon performs the surgery. A 12-month waiting period applies.
Cancer treatments
Covers costs for and relating to cancer treatment, including:
- Chemotherapy, radiotherapy, and brachytherapy
- Hospital accommodation (e.g. the admitted patient’s bed, a private room, excludes suites)
- In-hospital X-ray examination and ECG
- Intensive post-operative care and special in-hospital nursing
- In-hospital post-operative physiotherapy
- Ancillary hospital charges (e.g. dressings, sutures, needles, bandages)
- In-hospital pharmaceutical prescriptions (in line with the PHARMAC Pharmaceutical Schedule A to H; Ultimate Health Max only: also includes non-PHARMAC drugs approved by Medsafe)
Follow-up investigations for cancer
Registered specialist consultation and diagnostic investigation following cancer treatment.
We cover one registered specialist consultation, and relevant diagnostic investigations each policy year. We pay up to $3,000 each year for up to five consecutive years.
ACC top up
Covers the difference in cost payable by ACC for a physical injury and the actual costs of surgery or medical treatment.
Hospital specialist consultations
Covers registered specialist consultations including visits to seek a second opinion up to six months before and six months after admission to a recognised private hospital.
No limits on each consultation. No limit on the number of consultations.
Hospital diagnostic investigations
Diagnostic investigations up to six months before and six months after admission to a recognised private hospital.
No limits per diagnostic investigation. No limit on the number of investigations.
Post-hospital physiotherapy
Physiotherapy up to six months after hospitalisation.
No limits on each consultation. No limit on the number of consultations.
Post-hospital home nursing care
Home nursing care up to six months after hospitalisation.
We pay up to $300 each day and $6,000 each policy year.
Travel and accommodation
Travel costs for you and a support person, and accommodation costs for a support person when you need to travel further than 100km from where you live for treatment and are an admitted patient in a recognised private hospital.
Surgery and medical treatment: we pay up to $3,000 for travel and for accommodation, up to the balance available in the Hospital Surgical or Hospital Medical benefit limit, each policy year.
Cancer treatment: we pay up to the balance available in the Hospital Surgical or Hospital Medical benefit limit for both travel and accommodation each policy year.
Ambulance transfer
Road ambulance to and from a public hospital or recognised private hospital to another recognised private hospital.
Suspension of cover
After 12 months of continuous cover, you can put your cover on hold for up to six months due to unemployment or redundancy, for up to 12 months for parental leave, and up to 24 months for travel outside of New Zealand.
Waiver of premium
We cover the cost of all premiums on the policy for up to two years if a policyowner dies before age 70.
Funeral support benefit
We provide a cash payment if an insured person dies between the age of 16 and 64 (inclusive).
Ultimate Health: we pay $5,000
Ultimate Health Max: we pay $10,000
GP minor surgery
Minor surgery performed by a GP. Not limited to skin lesion surgery.
Ultimate Health: we pay up to $1500 each policy year.
Ultimate Health Max: we pay up to $5000 each policy year.
Registered specialist skin lesion surgery
Skin lesion surgery performed by a registered specialist.
Ultimate Health: we pay up to $6,000 each year.
Ultimate Health Max: unlimited up to the hospital surgical maximum each policy year.
Varicose veins surgery
Varicose vein surgery performed by a registered specialist or medical practitioner who is registered with the Medical Council of New Zealand and a fellow of the Australasian College of Phlebology.
No limit on the number of procedures.
Non-surgical hospitalisation
Covers medical treatment (not involving surgery) in a recognised private hospital in relation to a medical condition (e.g. heart disease, asthma, pneumonia or diabetes).
We also cover the cost of associated intensive nursing care, X-rays, disposables and consumables, dressings and in-hospital pharmaceutical prescriptions (in line with the PHARMAC Pharmaceutical Schedule A to H; Ultimate Health Max only: also includes non-PHARMAC drugs approved by Medsafe).
In addition, this benefit covers less invasive procedures as an alternative to surgery.
Public hospital cash benefit
Provides a cash payment when you are admitted to a public hospital in New Zealand for three or more consecutive nights.
We pay up to $300 each night for the third and each subsequent night and up to $3,000 each policy year.
Major diagnostics (not related to hospitalisation)
Covers for the following diagnostic investigations, whether or not you have been hospitalised:
- Arthroscopy
- Capsule endoscopy
- Colonoscopy
- Colposcopy
- CT Scan
- CT Angiogram
- Cystoscopy
- Gastroscopy
- MRI Scan
- Myelogram
- PET Scan
No limit per diagnostic investigation. No limit on the number of diagnostic investigations each year.
Parent accommodation
Accommodation costs for a parent or legal guardian accompanying an insured person under age 20 (inclusive) who is being treated in a recognised private hospital.
We pay up to $300 each night, and up to $3,000 each policy year.
Post-hospital therapeutic care
Includes osteopathic and chiropractic treatment, speech and occupational therapy, and dietician consultations up to six months after admission in a recognised private hospital.
We pay up to $1,000 each policy year.
Overseas treatment
Covers treatment and travel costs when treatment cannot be provided at all in New Zealand and the Ministry of Health has declined funding.
We cover up to $30,000 for each overseas treatment.
Cover in Australia
Covers costs for treatment undertaken in a recognised private hospital in Australia.
We pay up to the cost that would be payable in New Zealand for treatment performed in New Zealand.
Intravitreal eye injections
Intravitreal injections administered by a registered specialist and the cost of drugs administered (in line with the PHARMAC Pharmaceutical Schedule A to H; Ultimate Health Max only: also includes non-PHARMAC drugs approved by Medsafe).
We pay up to $3,000 each policy year.
Obstetrics
Treatment by an obstetrician for assessment and monitoring of recognised risk factors.
Ultimate Health: we pay up to $2,000 each pregnancy
Ultimate Health Max: we pay up to $4,000 each pregnancy
Loyalty benefit – sterilisation
After two years continuous cover, we cover the cost of a male or female sterilisation as a means of contraception.
Ultimate Health: we pay up to $1000.
Ultimate Health Max: unlimited up to the hospital surgical maximum.
Loyalty benefit – wellness
Provides you with a reimbursement every three years of continuous cover to help proactively take care of your health through a check up with a GP.
We pay up to $100 every three years per insured person aged 21 or over.
ACC treatment injury
Covers the cost of surgical treatment for any injury which occurred during treatment.
Delayed Care
Covers overseas treatment if you need to wait for treatment in a recognised private hospital in New Zealand for six months or longer.
We pay the cost that would be payable in New Zealand for treatment performed in New Zealand.
Medical misadventure
We provide a lump sum payment of $30,000 if an insured person dies due to a medical misadventure.
Pre-existing cover for newborns
Cover for pre-existing conditions (other than congenital) for dependent children when added within four months of birth.
Non-PHARMAC drugs
Covers the cost of drugs that are Medsafe approved but not subsidised by the government
Ultimate Health: we pay up to $20,000 each policy year for chemotherapy
Ultimate Health Max: we pay up to the balance available in the Hospital Surgical or Hospital Medical benefit limit each policy year
Breast symmetry post mastectomy
Following a mastectomy covered by nib, we cover the cost of reconstruction of the affected breast and/or reduction of the unaffected breast to achieve breast symmetry.
Medical tourism benefit
If the treatment is available in New Zealand within six months, we cover the costs of treatment in the country of your own choice.
We pay up to 75% of the cost that would be payable in New Zealand for treatment.
Premium waiver extension
We cover the cost of all premiums on the policy for up to six months if the policyowner is diagnosed with a terminal illness before age 70.
Cancer treatment accessories support
Cover the cost of a wig, hat, scarf or mastectomy bras during or within six months after cancer surgery or treatment.
Cancer treatment counselling and support services
Covers the cost of counselling and support services that occur within six months after an admission to a recognised private hospital for a cancer surgery or treatment.
Cardiac counselling and support services
Covers the cost of counselling and support services that occur within six months after an admission to a recognised private hospital for a heart surgery.
Hospice care
Provides a payment when you are admitted to a Hospice for three or more consecutive nights.
We pay up to $300 each night for the third and each subsequent night and up to $3,000 each policy year.
Loyalty benefit – bilateral breast reduction
After 3 years’ continuous cover, we pay up to $10,000 towards the cost of bilateral breast reduction surgery for eligible customers.
Loyalty benefit – bariatric surgery
After 3 years’ continuous cover, we pay up to $10,000 towards the cost of sleeve gastrectomy, gastric banding or gastric bypass surgery for eligible customers.
