How does an excess work in health insurance?

AIA’s Private Health and Private Health Plus cover lets you choose the excess that best suits your needs. The higher the excess the lower your premium. If an excess is payable you will only pay it once per life assured per policy year and not for every claim, and some benefits do not have an excess at all. When your medical invoices have been received, AIA will pay the providers, less any excess. The treatment provider will usually invoice you for the excess after payment is received from AIA.

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Private Health Insurance

Q: What are the benefits of AIA Private Health?

Key benefits of AIA Private Health: No annual limit on the amount you can claim for surgeries $500,000 extensive cancer cover for every stage, from diagnosis, to treatment and recovery Up to $200,000 for major diagnostic imaging and testing Other benefits such as: Overseas treatment Mental health support Parent accommodation Obstetric care allowance Parents grieving benefit Public hospital cash grant Waiver of premium Health screening Reproductive health

Health insurance that gives you access to private medical care when you need it most.

What is private health insurance?

AIA Private Health insurance covers many health conditions and allows faster access to urgent treatment when you need it most. With private medical insurance you also have the freedom to choose your own specialist and receive medical care according to your preferences.

Health insurance gives you peace of mind, knowing that you can manage unexpected medical bills. Surgery costs, imaging and tests to confirm a medical diagnosis, cancer cover, overseas treatment options, hospital costs and many more are covered by health insurance. You can also choose to upgrade your health insurance to AIA Private Health Plus to access even more benefits. Compare health insurance options below.

AIA Vitality is our personalised, science backed health and wellbeing programme that supports you every day to make healthier lifestyle choices. It takes you on a journey to better health - where you get to know your health, improve it, and enjoy the rewards for doing so.

Add AIA Vitality when you purchase private health insurance for $11.50 per month to receive:

an initial 10% premium discount* on your first year's premium
earn up to $560 in vouchers or Airpoints Dollars™ per membership year
exclusive rewards and discounts from our partners.

*T&C's apply.

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Why do I need health insurance if we have a public health system?

New Zealand's public health system provides free or low-cost health care to New Zealanders and the Accident Compensation Corporation (ACC) for accidents. However, relying on the health system on its own may result in long waiting lists and delayed treatment.

With private health insurance you can ensure that your health remains a priority, regardless of what happens in the future. You can trust that you will have financial support with medical expenses, often enabling you to access treatment faster than possible with the public health system and with greater choice of specialist.

What is a health insurance excess and how does it work?

When you take out AIA Private Health insurance, you are required to choose your excess. The excess is the amount you need to pay before you make a claim, and can be a way of managing cost. The higher your excess, the lower your premium will be.

View more information about excess options.

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Did you know?

In 2023, we paid over $143 million in claims for health insurance. Annual health insurance claims increased by 6% due to escalating costs and increase need for healthcare.

AIA Private Health insurance benefits^{^}

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Surgery benefits

Inpatient treatment costs

Covers costs associated with surgery, examples include Surgeon, Anaesthetist, Radiologists and Hospital fees.

Access to pre and post surgery support services

Consultations, physiotherapy and prescription drugs

Unlimited

Minor surgical procedures performed by a GP

Up to $3,000 per policy year across both benefits. (Daily limits may apply)

Surgical costs for specified congenital conditions

$2,000 per lifetime

Cancer cover benefits

Treatments and procedures

Including the cost of Pharmac and non-Pharmac subsidised Medsafe indicated cancer chemotherapy drugs

Consultations, tests and diagnostic imaging

Breast reconstruction following mastectomy

Breast symmetry following mastectomy

Prophylactic surgery following cancer

Surgery includes prophylactic mastectomy and/or oophorectomy only, and where criteria is met.

Prostate brachytherapy

$500,000 per policy year

Cancer diagnostics

Covers specialist costs used to confirm a cancer diagnosis.

No specific benefit but may be covered by other benefits of the policy

Post-cancer treatment care and support

$1,000 per policy year

Public hospital cancer treatment cash benefit

$5,000 per lifetime

Palliative and respite care

$1,500 per lifetime

Medical hospitalisation and testing

Hospitalisation

Covers costs for a treatment of a condition which doesn’t require surgery, examples include hospital accommodation costs, specialist fees, and other ancillary hospital charges.

$500,000 per policy year

Major diagnostic imaging and tests

Cover costs of diagnostic tests and imaging, some examples include Angiogram, Colonoscopy, CT scans, Laparoscopy, Hysteroscopy and MRI scans.

$200,000 per policy year

Public hospital cash grant

$300 per day,
Up to $3,000 per policy year

Loyalty benefits

Cover that comes into effect after a certain period of time has passed

Bilateral breast reduction allowance

Bariatric surgery allowance

$7,500 per lifetime across both benefits (after three years)

Sterilisation

$5,000 per lifetime (after one year)

Cancer health screening allowance

No specific benefit but may be covered by other benefits of the policy

Overseas treatment benefits

Voluntary treatment in Australia

Covers costs for the approved treatment, procedure, consultation, test, diagnostic imaging, support, or care at a health facility approved by AIA.

Treatment overseas where the waiting period in New Zealand is greater than six months

Covers costs for a medically necessary treatment or procedure unable to take place in New Zealand within six months.

100% of the reasonable charges payable in New Zealand

Voluntary treatment overseas (other than Australia)

Covers costs for the approved treatment, procedure, consultation, test, diagnostic imaging, support, or care recommended by a New Zealand specialist.

85% of the reasonable charges payable in New Zealand

Treatment overseas not available in New Zealand

Covers costs for a medically necessary treatment or procedure recommended by an approved specialist.

$30,000 per policy year

Other support benefits

Mental health support benefit

$2,500 per policy year

Parent accommodation benefit

Treatment away from home in New Zealand

Up to $3,000 per policy year across both benefits.

(Daily limits may apply)

Obstetric care allowance

$2,000 per policy year

Parents grieving benefit

$2,000 per child

Waiver of premium on death

Two years free cover (policy)

Optional upgrade – Private Health Plus

As an optional benefit, you can upgrade your Private Health insurance to include additional cover for specialist consultations and tests, reproductive health and a health screening allowance.

Additional diagnostic imaging and tests

Covers costs for tests not related to treatment or surgery referred by a medical practitioner or specialist.

$100,000 per policy year

Additional specialist consultations

Covers costs for consultations (including second opinions) with a specialist referred by a registered medical practitioner.

$10,000 per policy year

Pregnancy, maternity and infertility allowance

Covers costs for obstetric care, including scans, infertility diagnosis and treatment at an approved facility.

$1,500 per policy year
(after two years)

Health screening allowance

Covers screening costs for approved procedures. Examples include bone, bowel, breast, cervical, heart, prostate, skin, aortic aneurysm screening, hearing, and eye tests.

$500 (after three years) or $750 for AIA Vitality members (after two years)

^This is a summary only. For all terms, conditions, limits and exclusions, please read the policy wording.

Do you want additional peace of mind?

Explore our other insurance products available to extend your cover

Life Insurance

Provides a lump sum payment if you were to pass away.

Find out more

Trauma Insurance

Financial support if you or your child become seriously ill or injured.

Find out more

Total Permanent Disablement Insurance

Provides a lump sum payment if you become permanently disabled and are unable to work due to accident or injury.

Find out more

More about AIA Health Insurance

FAQs

View frequently asked questions about AIA’s Health Insurance products

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What are the benefits of AIA Private Health?

Key benefits of AIA Private Health:

No annual limit on the amount you can claim for surgeries
$500,000 extensive cancer cover for every stage, from diagnosis, to treatment and recovery
Up to $200,000 for major diagnostic imaging and testing
Other benefits such as:
- Overseas treatment
- Mental health support
- Parent accommodation
- Obstetric care allowance
- Parents grieving benefit
- Public hospital cash grant
- Waiver of premium
- Health screening
- Reproductive health

Is medical insurance and health insurance the same?

In New Zealand medical and health insurance is essentially the same. Products will differ between insurance providers. They may have different benefits and limits in their policies. It is important to understand what those differences are.

Please contact your insurance adviser or request an adviser call to discuss your needs.

What should I know before buying health insurance?

Speak to an insurance adviser to guide you through your questions and help you decide what cover you need.
Consider your personal situation and your ability to pay for expensive medical costs and surgery.
Many health issues that Kiwis face are either not accidental or can mean delayed treatment due to long waiting lists and can cost thousands of dollars. Health insurance removes the worry around unexpected medical bills so you can focus on getting the right treatment and start your recovery sooner.
Know what the policy covers and what it does not cover. Most policies have limitations and exclusions. For example, pre-existing conditions may not be covered.
Know what the definitions in the policy mean. These can differ depending on the insurance company that provides your cover.

What questions should I ask when buying health insurance?

The questions you could ask when considering your health insurance options are:

What benefits the policy provides and what limitations apply to those conditions
What is not covered under the policy (aka policy exclusions)
What your excess options are and how those affect your premium
How pre-existing conditions are treated and how those may affect your policy and premium. You must disclose all pre-existing conditions to the insurance provider.

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How do I make a claim?

Contact your insurance adviser or insurance company as soon as possible once you know that you may have a claim.

With AIA you can easily contact our claims department online by live chat, telephone or email.

You may need prior approval before undertaking treatment. AIA will help you with this and arrange to pay providers directly if approved. For more information contact your adviser or visit aia.co.nz/claims

What if I have a pre-existing medical condition?

If you have a pre-existing medical condition it is important that you advise your insurance company when applying for cover. Your insurance adviser will help you with this.

It does not automatically mean that you won’t be covered for that condition, however you must disclose all pre-existing medical conditions to enable the insurance provider to assess your application with all relevant information.

Policy Wordings

AIA Private Health

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Private Health

Health Waiver Of Premium

Disclaimer

Other things you should know: the availability of insurance cover is subject to your application being approved. All applications are subject to individual consideration. Special conditions, exclusions and premium loadings may apply. This insurance is underwritten by AIA New Zealand Limited (‘AIA’). For full details of the products and benefits offered by AIA, please refer to the policy document(s) which are available from AIA. The information contained in this publication is general in nature and is not intended as advice. It may not be relevant to individual circumstances and before making any insurance decision, you should consult a professional Adviser.

A note on exclusions and benefits
This insurance (including the built-in and optional benefits) is subject to certain stand down periods and exclusions. Please also note that the optional benefits are subject to an increase in premium and their own terms and conditions.

Terms and conditions apply
AIA Vitality is available with eligible AIA health or life insurance policies and has a monthly membership fee of $11.50 (including GST). View the full AIA Vitality terms and conditions.

Your Duty of Disclosure

When you apply for insurance with AIA New Zealand Limited, you have a legal duty of disclosure to AIA.

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