Here we’ll answer some of the most common questions around pre-existing conditions and health insurance. It’s important to discuss your condition with your health insurance provider and be clear about what is and isn’t covered before commencing cover.
What is considered a pre-existing condition?
A pre-existing condition is a condition, or a sign or symptom of a condition that –
you knew about before applying for health cover
you’ve previously sought diagnosis for or asked for medical advice about
a reasonable person would seek diagnosis or medical advice about
was identified in diagnosis, even if you didn’t know about it or
was treated before your cover starts
Typically, most health insurance policies don’t cover pre-existing conditions, but some may cover them following a specified period of time from your join date. In some cases, certain pre-existing conditions may not be covered at all. Check this video for more information on pre-existing conditions.
How long is the waiting period for pre-existing conditions cover?
Waiting periods refer to the period of time after your join date, during which your insurer won’t pay a claim for a specific benefit.
There can be different waiting periods for different benefits, different pre-existing conditions and types of cover.
In the case of pre-existing conditions, waiting periods are usually longer. Typically, the waiting time varies between 12 months – four years.
nib offers cover for many pre-existing conditions with a waiting period. Read about how it differs on nib hospital covers.
Will health insurance cover my pre-existing condition?
Health insurance may cover many of your pre-existing conditions after the applicable waiting period.
Once you’ve been with nib on either Premium Hospital or Standard Hospital cover for three years, some pre-existing conditions are covered, allowing you to claim on them. This is a loyalty benefit and our way of saying thanks for being with nib.
It’s important to know though that nib’s Premium or Standard Hospital cover will never provide cover for pre-existing conditions that relate to cardiovascular, cancer, hip or knee, back, transplant surgery, reconstructive or reparative surgery.
Pre-existing conditions shouldn’t affect what you pay as a premium.
Do I have to pay more for health insurance in NZ if I have a pre-existing condition?
Pre-existing conditions don’t usually affect the premiums you pay. However, there is generally a waiting period before these conditions are covered. It is worth noting that not all health insurance providers offer cover for pre-existing conditions; nib is among the few that does (although there are some pre-existing conditions that are never covered).
Am I covered if I find out about a pre-existing condition after taking out health insurance?
You would be covered with some of nib’s covers after three years, as long as it wasn’t a pre-existing condition listed above that’s never covered.
I have asthma. Will I be covered?
Asthma is a common disease of the airways. It causes the muscles in the airways to tighten and become swollen, making it difficult to breathe.
nib’s Everyday policies cover some of the cost of visits to the GP, up to your annual limits.
And with nib’s Premium Hospital or Standard Hospital cover you would be covered for hospitalisation related to asthma after serving the three year waiting period for pre-existing conditions. If it is not a pre-existing condition there is no waiting period for this.
Is stress or anxiety considered pre-existing conditions?
Yes, and these are general exclusions of our Premium Hospital and Standard Hospital policies, so are not covered. With Everyday cover, nib will cover some of the cost of mental health consultations up to your annual limit, regardless of whether the condition is pre-existing.
Is age-related degeneration of bones or other parts of the body considered a pre-existing condition?
If signs or symptoms of degeneration of the body started before applying for health insurance, or related to a past injury/pre-exising condition, it will be considered a pre-existing condition.
If I have been treated for a disease and am now in the clear by medical professionals, will I still need to report it as a pre-existing condition?
If you have a policy like nib Premium Hospital or Standard Hospital cover you won’t be asked medical questions up-front when you join, but should disclose pre-existing conditions if you need to make a hospital claim.
Otherwise if you’re asked about pre-existing conditions when joining health insurance, you should disclose any conditions you’ve previously had, even if you’ve had the all-clear from your doctor.