People are often confused about what Health Insurance should cover or what they are currently cover for so hopefully this article shed some light upon it for you.

The base option of the current policies offered by the main Health Insurers:   AIA, ING, Southern Cross, Sovereign, TOWER provides cover for Hospitalisation for Surgical and Non-Surgical treatments.  So what are the main exclusions under a base policy:

• Cosmetic surgery, medical costs covered by ACC, Emergency admission to a hospital, AIDS to name the main ones

Something to note is that most base policies cover Specialist costs to a certain level if they are several months either side of a surgical operation in a hospital.

So why take out Medical Insurance ?

0. You get a greater choice of when, where and how you get treated
0. No added stress to pay for expensive treatments
0. Avoid long delays in the public health system
0. Get cover now for health issues which could arise in the future
0. Get access to the latest procedures and technology

In most cases if you are admitted to an emergency department of a public hospital they will not allow you to move to a private hospital and nor will the private hospital be ready to cope with your emergency. Generally you have the best doctors and surgeons working in the emergency department keeping their skill levels up. However if you have an operation that you know you need which can be scheduled in then this is where your medical insurance comes into play. Having this cover means you can choose where and when you have the operation done.

Some policies cover doctors, optical and dentist costs . Unfortunately a lot of these coverage levels can be quite limited and really is this the number reason why you would take out medical insurance, would this be waiting lists you wish to skip or access to treatment outside the public system? The average dental cover in New Zealand is around $400 per year so if you needed a tooth capped then you are going to be dipping into your own pocket; likewise the optical coverage offered is not adequate.

You end up paying quite a large portion of your medical insurance towards these add-ons and for example we estimate on average you need to be going to the doctors at least 5 times a year to make it worthwhile having this cover financially. And these days with the discounts offered for children and for adults going to their local doctor it often does not make sense having this cover. Many people complain about the cost of their insurance as this is one sure way to reduce your premiums!

In fact the only option we generally recommend adding to a base policy is the specialist option which allows you to pay for specialist costs if you were referred by a doctor - as the base policy will not pay in this situation.

Pre existing conditions   depending on the conditions when you took out your medical insurance you may have pre existing conditions which are not covered, this is quite common and each pre-existing condition not covered needs to be assessed whether it is such a big deal to not be covered. For example if your child had an asthma exclusion, in the event of them suffering an asthma attack they would either use their inhaler or be taken to the emergency department to be administered oxygen.

Pharmac Funding PHARMAC is a crown entity and its objective is to secure for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the funding provided. Medical Insurance policies all will pay for treatment that are on the Pharmac list however if you want treatment outside this then out of the current medial insurance products available only ING will cover non-Pharmac treatment. Herceptin until recently was not on Pharmac's list and this was being used for the treatment of breast cancer.

Another example is a lady whom had cancer in her lymphatic system she applied to her Health Insurer for the drug Rituximab which at the time was not covered by Pharmac and not by her medical insurance, her insurers comment was "the public health system should remain New Zealanders' first port of call for cancer treatment". Please click here for the video and here for the article