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What is a pre-existing condition?

Pre-existing condition means:

Any sign or symptom of any condition, or any condition:

• which the policyowner or the insured person was first aware of, or
• for which the insured person first sought diagnostic investigation or medical advice, or
• that would cause a reasonable person in the circumstances to first seek diagnostic investigation or medical advice, or
• any condition, which was evident (even if the insured person was not made aware of it) when they sought diagnostic investigation, medical screening or medical advice, or
• any treatment of any condition which the insured person had, on or before the earliest of the following that applies to the insured person: before their commencement date, effective date or join date.

Standard Hospital and Premium Hospital

Standard Hospital and Premium Hospital do not cover any pre-existing conditions for the first three years. After three years of continuous cover from the commencement date, effective date or the join date (as applicable), it covers costs relating to health services for pre-existing conditions excluding those that relate to any of the following conditions: cardiovascular, cancer, hip or knee, back, transplant surgery, or reconstructive or reparative surgery, which are not covered at any time. For further information, please refer to benefit 13 of the Standard Hospital policy document or benefit 18 of the Premium Hospital policy document.

Standard Everyday and Premium Everyday

Standard Everyday and Premium Everyday provide cover for health services relating to the benefits insured by this cover once waiting periods have been served, whether or not they are related to and/or consequences of any pre-existing conditions.

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Eligibility for nib health cover

Standard Hospital and Premium Hospital

Provides cover for an insured person who:

• is a citizen or permanent resident of New Zealand living in New Zealand; or
• is an Australian citizen or permanent resident who has lived, or intends to live, in New Zealand for two years or more; or
• is permanently employed in New Zealand and holds a current New Zealand work permit which has been issued for at least two years with at least 12 months remaining; or
• is entitled to publicly funded health and disability services provided by the New Zealand Government.

Standard Everyday and Premium Everyday

Provides cover for an insured person who:

• is lawfully residing in New Zealand.

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Privacy policy

We are committed to protecting the privacy and security of the personal information we collect. We have implemented measures to comply with our obligations under the Privacy Act 1993, including the Health Information Privacy Code 1994. This section explains how we may collect and use personal information.

Why does nib collect my personal information?

We collect personal information primarily to enable us to provide insurance benefits and related services. If the information provided to us is not accurate or complete, we may not be able to provide an accurate quote, or provide benefits for the requested insurance or related services.

What personal information does nib keep?

The personal information we hold will depend on whether someone is an insured person or a recognised provider and which services they have used. Information may include:

• name, address, contact details, date of birth, email address;
• payment history;
• current or past details of private health insurance or other nib insurance, including level of cover;
• claim details;
• health information including pre-existing condition information;
• employment or membership details where the insurance policy is connected to a workplace or association; and
• travel plans, in relation to nib travel cover.

How does nib collect personal information?

We may collect personal information directly, in person or by phone or internet (including through the 'my nib' portal or nib mobile phone applications) when someone:

• applies to become a customer or recognised provider, including when someone starts and does not complete an online application to become a customer;
• becomes a customer as part of a workplace or association scheme;
• provides information during the course of their policy or relationship with nib;
• requests information concerning our services; or
• lodges a claim.

How does nib use personal information?

The information we collect is used to:

• provide benefits for insurance and related services;
• determine eligibility to provide or receive an insurance or related service;
• administer insurance and related services;
• develop, promote or market our current and future insurance and related services;
• prevent, detect and investigate any fraud; and
• comply with laws and regulations.

If we use personal information for direct marketing or research purposes, we will do so in accordance with the Privacy Act 1993 including the Health Information Privacy Code 1994 and any electronic marketing or research correspondence sent to an individual will give them the opportunity to “opt out” of receiving any further marketing or research correspondence.

Will personal information be given to anyone else?

In providing our services and using personal information in accordance with this Policy, we may collect information from or disclose a person’s personal information to:

• other nib companies;
• your financial adviser and the dealership group that they are a member of;
• the Group Administrator where the insurance policy is part of a workplace or association scheme;
• insurance service providers including other insurers and reinsurers, recognised private hospitals and public hospitals, doctors and medical specialists and professional medical authorities, including the ACC and the Ministry of Health, and in relation to nib travel cover, investigators and emergency assistance providers;
• our contractors and service providers performing services including (but not limited to) legal services, marketing, market research, mail house services, and product development services;
• our existing and future strategic partners in respect of covers and services provided under a distribution arrangement;
• industry bodies, to aid in the prevention, detection and investigation of fraud; and
• law enforcement agencies, regulators or other parties as required by law.

Each policyowner and insured person authorises the collection of this information from and the disclosure of personal information to such parties for the purposes set out above.

We may also be required to disclose an insured person’s personal information to other individuals on their policy, or to individuals to whom the insured person has granted authority to act on their behalf. At the time of joining nib, the person applying for the policy authorises us to share information with other individuals on the policy. For example, this means we may make the policyowner aware of the details of all benefits and services claimed on the policy.

Personal information may be disclosed to third parties overseas where those parties are one of the parties listed above.

We will not disclose an insured person’s personal information to anyone, other than as above, unless:

• the insured person authorises us to do so;
• the insured person's safety or the safety of others in the community is at risk; or
• we are required or permitted by law.

How does a person gain access to their personal information?

Any person who we hold information about has a right to access, and request correction of, their personal information.

You can request details of your personal information by contacting us at 0800 123 nib (0800 123 642), or by emailing us at [email protected]

Can personal information be checked and corrected?

The accuracy of personal information is important to us. We will take reasonable steps to ensure that personal information is accurate, complete and up-to-date. We rely on persons who have a relationship with nib to advise of any changes to their contact details and any other personal information. Where possible please provide an email address. If a person believes that any personal information we hold is not accurate, complete or up-to-date, the person should contact us immediately.

Is personal information secure?

We take all reasonable steps to ensure personal information is kept secure. We protect the privacy and security of the personal information we hold through the use of encryption, security access, firewalls and computer security systems. We have physical, electronic and procedural safeguards to protect your personal information which is held by us, and access to information stored electronically is restricted to staff whose positions require access to this. We may also use third party data storage providers and servers to store your personal information.

Need more information?

Personal information is collected and held by nib nz limited, 48 Shortland Street, Auckland. In relation to nib travel cover, personal information will also be collected and held by Cerberus Special Risks Pty Limited, 680 George Street, Sydney, Australia. For further information regarding this privacy policy or to discuss the steps we have taken to protect personal information and privacy, contact our Privacy Officer by calling 0800 123 nib (0800 123 642), or by emailing [email protected]

Changes to this privacy policy

We reserve the right to change this privacy policy from time to time. This privacy policy was last updated in September 2016.

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Who can I add to my policy?

The person completing this application is the policyowner.

The policyowner can add their partner, dependent child, parent or grandchild to their policy. We will charge an additional premium for each insured person added.

Dependent child means your child or children under the age of 21 years.

Partner means your spouse or a person who cohabits with you in a nature of a marital, de-facto or civil union relationship.

Policyowner means a person who administers the Policy and whose name is on the Acceptance Certificate or Renewal Certificate (whichever is the later) as 'Policyowner(s)'.

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Financial Strength Rating

nib nz limited has an A- (Strong) Financial Strength Rating issued by S&P Global Ratings Australia Pty Ltd

The rating scale is: AAA (Extremely Strong), AA (Very Strong), A (Strong), BBB (Good), BB (Marginal), B (Weak), CCC (Very Weak), CC (Extremely Weak), SD or D (Selective Default or Default), R (Regulatory Action), NR (Not Rated). Ratings from 'AA' to 'CCC' may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories.

For more information, visit www.spratings.com/understanding-ratings

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Direct Debit Authority Terms and Conditions

Specific conditions relating to notices and disputes
I may ask my bank to reverse a direct debit up to 120 calendar days after the debit if:

• I don’t receive a written notice of the amount and date of each direct debit from the initiator, or
• I receive a written notice but the amount or the date of debiting is different from the amount or the date specified on the notice.

Notice about direct debits
The initiator is required to give a written notice of the amount and date of each direct debit in a series of direct debits no later than the date of the first direct debit in the series. The notice is to include:

• the dates of the debits, and
• the amount of each direct debit.

If the bank dishonours a direct debit but the initiator sends the direct debit again within 5 business days of the dishonour, the initiator is not required to give you a second notice of the amount and date of the direct debit.

Changes to direct debits
If the initiator proposes to change an amount or date of a direct debit specified in the notice, the initiator is required to give you notice:

• no less than 30 calendar days before the change, or
• if the initiator’s bank agrees, no less than 10 calendar days before the change.

Your first direct debit
We will send you confirmation including details of when your first payment will be deducted from your bank account and the terms and conditions of the arrangement no later than 5 business days from now. ×

Which conditions are never covered?

Pre-existing conditions that relate to any of the following categories are not covered at any time:

• Cancer
• Cardiovascular conditions and some risk factors
• Hip, knee or back
• Transplant surgery
• Reconstructive or reparative surgery

Please see the policy document for the full terms and conditions of what we never cover on this policy.

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Pre-existing conditions special offer

An ‘abnormal medical test’ could be any medical tests with unusual results outside of a normal range, for example a blood result indicating low iron

or

• Any abnormal blood test results i.e. Liver function
• An abnormal cervical smear
• Abnormal urine test which can indicate urinary tract infections

An ‘abnormal medical assessment’ would include any consultation or medical investigation including medical imaging, ultrasounds, and MRI’s where the results have identified a sign or symptom of a medical condition.

For example:

• Abnormal eye test
• Abnormal x-ray or ultrasound of any bones, muscles, ligaments, tendons
• Molemap that has found suspicious moles/skin lesions
• GP visit which results in a referral to a Specialist or diagnostic investigation or any form of treatment including prescriptions

The examples provided are not a complete list of all relevant tests or assessments. If you’re unsure how to answer this question, please give us a call on 0800 758 758 0800 758 758.

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AA Health Pre-Existing Conditions (PEC) Offer – Terms and conditions

1. This offer is open to eligible customers aged 18 years old and over, who:

• purchase an AA Health Private Hospital or Private Hospital & Specialist policy between 17 February and 29 March 2020, while we have a remaining allocation of eligible policies;
• are new AA Health customers, meaning not current AA Health customers as at 17 February 2020; and
• meet the eligibility criteria in paragraph 3 of these terms and conditions. All insured persons on the policy must meet the eligibility criteria to receive this offer.

2. There are a limited number of policies available for this offer. If all available polices are sold before the offer end date (29 March 2020), the offer will be withdrawn and no new customers will be able to take up the offer.

3. All eligible customers on the policy:

• Must be aged 60 years or under at time of application.
• Must disclose to us any abnormal medical test results or assessments in the 12 months prior to application.
  • An ‘abnormal medical test’ includes any medical tests with unusual results outside of the normal range, for example a blood result indicating low iron or test indicating high cholesterol.
  • An ‘abnormal medical assessment’ includes any consultation or medical investigation including medical imaging, ultrasounds, and MRI’s where the results have identified any sign or symptom of a medical condition.

This offer is only available to customers who have not had any abnormal medical test results or assessments in the 12 months prior to application.

If, at any time, we find that any customer on a policy received an abnormal medical test result or abnormal medical assessment in the 12 months prior to application, contrary to his or her statement then, at our discretion, the pre-existing condition stand down periods may be reinstated and/or we may decline to pay any future claims (or seek to recover the amount of any paid claims) relating to that incorrect statement.

4. For customers who meet the eligibility criteria in paragraphs 1 and 3:

• The usual three year stand down period for eligible pre-existing conditions (except the conditions described in paragraph 5) for any Hospital cover will be waived; and
• The 12-month wisdom teeth waiting period for Private Hospital and Specialist cover will be waived.

5. Some pre-existing conditions are not covered in this offer and no cover will be provided. These pre-existing conditions are those that relate to cardiovascular conditions and some risk factors, cancer, hip, knee or back, transplant surgery or reconstructive or reparative surgery. Please see the policy document for further information on these permanent pre-existing condition exclusions.

6. The offer is not transferable or redeemable for cash. This offer can’t be used in conjunction with any other offers.

7. This offer can be redeemed by phoning AA Health on 0800 758 758, completing the online application at health.aa.co.nz or visiting one of the AA Centres nationwide.

These terms may be updated or modified by us (provided this doesn't prejudice anyone who has already received the offer), and were last updated on 10 January 2020.

This offer may be withdrawn by us once the allocation of eligible policies is met.

10. “We”, “us” and “our” means nib nz limited, the insurer of the AA Health products.

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