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.

You never know what could happen to you, right? So having good health cover may be a wise decision, even if you’re fit and well.

But for many people, it’s not the security of being covered against unexpected surprises they think about first. Instead, their focus is fear. In particular, the fear that they can’t get insurance cover for the health conditions they are already dealing with — anything from a weird looking mole to endometriosis. In this article, we’ll answer some of the most common questions around pre-existing conditions and health insurance.

Don’t worry - you have options

For many of us, fear can easily get in the way of doing the right thing. But finding out what health insurance could look like for you isn’t something to be intimidated by. 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, we define a pre-existing condition under our nib Standard and Premium Hospital policies as any sign or symptom of any condition, or any condition, that fits any of the following:

• Something you knew about before you applied for health cover (like a knee injury from football, or a bowel problem you’ve been waiting to see a specialist about)
• A condition, sign or symptom you’ve previously asked a health professional to diagnose or give you advice about
• Something a reasonable person would seek diagnosis or medical advice about
• Something that was identified in diagnosis, even if you didn’t know about it
• A condition, sign or symptom that was treated before your health cover started

Just because something fits one of those definitions, it doesn’t necessarily mean it won’t be covered. It may just mean it will have a wait 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
• A small group of conditions we don’t 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 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 for a nib Standard or Premium Hospital policy.

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. 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?

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 inflammatory condition of the lungs where the airway tightens in response to triggers, resulting in shortness of breath and wheeze as the main symptoms. It ranges from mild to severe but can be easily managed with regular use of inhalers.

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 nib’s Standard and Premium Everyday cover, we 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-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

Pre-existing conditions can happen to anyone. Sometimes it’s an illness and sometimes just bad luck. 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. We think that’s fair — and a lot better than fear.

If you’re still unsure, the best thing is to talk to nib or your insurance advisor. 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.

Information correct as at 19 February 2024