A Guide to Pre​-​​​Existing Conditions under nib Premium and Standard Hospital Cover

Understanding pre-existing condition cover under nib’s Premium Hospital and Standard Hospital Cover policies

The goal of health insurance is pretty simple. It's designed to allow you and your loved ones to live a full and happy life, by helping you to prevent or treat the things that could slow you down or impact your health.

Even if you’re fit and well, having health cover can provide reassurance for the future. After all, you never know what life might throw your way.

But when it comes to health insurance, one of the biggest questions people have is around pre-existing conditions. Many people aren’t sure what is - and isn't covered especially if they’re already managing a health concern, from a suspicious mole to endometriosis.

In this article, we’ll answer some of the most common questions around pre-existing conditions under nib’s Premium Hospital and Standard Hospital policies.

Don’t worry, you have options

For many of us, understanding health insurance and pre-existing conditions can feel overwhelming at first, but getting the right information doesn’t have to be intimidating. At nib, we make it easy to get and understand the information you need, so you can make informed choices and make health insurance work for you.

If you’re nervous about pre-existing conditions, talk to us and we can help you to understand your options. The earlier in life you talk to us, the more likely you can be covered for things that happen as you get older.

What counts as a pre-existing condition*?

At nib, a pre-existing condition under our nib Standard and Premium Hospital policies is defined as any sign, symptom, treatment, or surgery of any condition that happened on or before the insured person’s join date, that the policyowner(s) or another insured person:

• were aware of; or

• had an indication that something was wrong; or

• sought investigation or medical advice for; or

• would cause a reasonable person to seek diagnosis, care, or treatment.

Just because something fits one of those definitions, it doesn’t necessarily mean it won’t be covered. It may just mean there will be a waiting period before the pre-existing condition is covered.

Broadly speaking, pre-existing conditions fall under two categories when we’re looking at your cover options:

• conditions that we will cover after you’ve been with nib for a specific period of time; or

• a group of conditions we don’t ever provide cover for.

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 for a specific claim. 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. In the first three years following your join date, we won’t pay any claims that directly or indirectly relate to any pre-existing conditions. After three years of continuous cover following your join date, we’ll cover eligible pre-existing conditions. But remember, some pre-existing conditions are never covered. This applies to both our Standard and Premium Hospital policies.

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 policy for three years, following your join date, 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.

Do I have to pay more for health insurance in NZ if I have a pre-existing condition?

It depends on the health insurance product and how it is underwritten.

For some health insurance policies, pre-existing conditions may affect the terms offered, which can include premium loadings, exclusions or other underwriting decisions.

For the specific nib products discussed in this article (Standard Hospital and Premium Hospital policies), cover for many pre-existing conditions may be available subject to the policy terms and waiting periods.

Am I covered if I find out about a pre-existing condition after taking out health insurance?

It depends. You would be covered with some of nib’s policies 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 chronic respiratory condition, and how it’s handled depends on when your symptoms started:

• if it develops after you join: hospitalisation for asthma is covered as a new illness once your policy is active.

• if it's a pre-existing condition: you will be covered for eligible hospitalisation related to your asthma after completing your three-year pre-existing condition waiting period.

Additionally, if you add a Standard Everyday or Premium Everyday module to your policy, you can claim back a portion of your day-to-day GP visits and prescriptions used to manage your asthma up to your annual limits, regardless of whether it's pre-existing.

Is stress or anxiety considered pre-existing conditions?

Whether they are pre-existing or newly developed, psychological and psychiatric conditions (including depression and ADHD) are general exclusions under our Standard Hospital and Premium Hospital policies, meaning these are not covered.

However, if you add an nib Standard Everyday or Premium Everyday policy, you can claim back some costs towards everyday mental health consultations up to your annual limit, regardless of when your condition started.

Are pre-existing cancers covered?

In general, we don't cover pre-existing cancers. However, we do cover pre-malignant cancers if you've had appropriate treatment from a specialist or GP who's qualified to carry out that treatment. Some examples of pre-existing cancers we cover include:

• polyps of the bowel

• melanoma in situ

• basal cell carcinoma

• squamous cell carcinoma.

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 taking out health insurance, or are related to a past injury/pre-existing 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?

Yes. 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.

Fairness comes first

Health conditions can affect anyone at any stage of life. But the way we see it, everyone deserves access to good health cover. And whenever we can, we provide options to cover your pre-existing condition, so you’re not missing out. There are some pre-existing conditions however we do not cover.

If you’re still unsure about pre-existing conditions and how cover works, the best thing you can do is talk to nib or your insurance adviser. We can put your fears to rest and help you find a solution that works for you.

T&Cs:

*The pre-existing condition wording relates to nib Standard and Premium Hospital covers only.

Exclusions, waiting periods, eligibility criteria, benefit limits, excess payable, and full policy terms and conditions apply.