The short answer
Health insurance in New Zealand pays for private medical treatment: surgery, specialist appointments, diagnostic imaging, and on better plans, cancer drugs that Pharmac does not fund. The public system remains available to you either way — what you are buying is the ability to be treated on your timetable rather than the queue's.
Roughly Southern Cross holds about 60% of the market and nib about 15%, with AIA, Partners Life and others making up the rest. Pre-existing conditions are generally excluded, sometimes permanently.
Last reviewed 2026-07-30
What you are actually buying
It helps to be blunt about this, because health insurance is sold badly. You are buying four things:
- Time. Elective surgery in the public system runs on clinical priority. If your hip, knee, hernia or gallbladder is painful but not urgent, you can wait a long time — and if you are self-employed or on your feet for a living, waiting has a dollar cost.
- Choice. Your surgeon, your hospital, your date.
- Non-funded drugs. This is the one people underrate. Pharmac funds a narrower list of modern cancer medicines than several comparable countries. Better health policies include a non-Pharmac drug benefit, often $300,000–$500,000. For some diagnoses that benefit is the single most valuable thing in the policy.
- Diagnostics. Getting the scan quickly is often the difference between a fast answer and months of uncertainty.
Pre-existing conditions — the thing to understand before you apply
A pre-existing condition is anything you had symptoms of, sought advice about or were treated for before cover started — whether or not it was formally diagnosed. Insurers handle them in one of three ways: permanent exclusion, a time-limited exclusion, or a premium loading.
| Insurer | General approach |
|---|---|
| Southern Cross | Moratorium-style. Qualifying pre-existing conditions may become covered after 3 years of continuous cover on some plans, provided a benefit exists for the treatment. |
| nib | Waiting periods typically 12 months to 4 years. After 3 years on Premium or Standard Hospital cover some pre-existing conditions become covered — but cardiovascular, cancer, hip/knee, back, transplant and reconstructive conditions are permanently excluded. |
Summarised from the insurers' published policy material, July 2026. Plans change; check the current policy document before relying on this.
Waiting periods on everything else
Even with a clean history, benefits switch on at different times: pregnancy commonly has a 12-month wait where it is covered at all (most policies exclude normal pregnancy), and dental and optical extras usually have 2–6 month waits. See waiting periods and stand-downs.
The public system decides when. Health insurance is you deciding when.
Excess: the lever that changes the price most
Moving from a $250 excess to $2,000 or $4,000 can cut a premium substantially. It is the most under-used adjustment in the market. The logic is straightforward — if you could comfortably find $2,000 in an emergency, you are paying a lot each month to insure an amount you do not need insured. What you actually want protection against is the $40,000 surgery, not the $900 one.
Is it worth it?
Honestly: it depends on a number, and the number is your tolerance for waiting. Health insurance is the one cover on this site where a reasonable, financially literate person can decide "no thanks" and be right. If you have strong savings, a job that tolerates absence, and no family history that worries you, self-insuring the elective-surgery risk is defensible.
What is not defensible is assuming the public system covers modern cancer drugs. It funds fewer than people expect, and that is the part of the decision most often made on a wrong assumption.
Costs by age are on the health insurance cost page.
Common follow-up questions
Does health insurance cover GP visits?
Base hospital plans generally do not. GP visits, prescriptions, physio, dental and optical usually sit in an optional "everyday" or "extras" module that costs extra and, for many people, returns roughly what it costs. The high-value part of health insurance is the surgical and non-Pharmac drug cover, not the everyday module.
Does health insurance cover pregnancy and birth?
Normal pregnancy and childbirth are excluded by most New Zealand policies — maternity care is publicly funded here. Some policies cover complications of pregnancy after a waiting period of around 12 months. If you are planning a family, this is worth checking specifically rather than assuming.
If I switch insurers do I lose my cover for existing conditions?
Frequently yes, and this is the single most expensive mistake in health insurance. Switching restarts underwriting, so conditions that developed while you were covered can be excluded by the new insurer. A cheaper premium is not a saving if it silently removes cover for the thing most likely to happen to you. Any adviser worth their fee will check this before recommending a switch.
Can my employer's scheme cover me instead?
Group schemes are often good value and sometimes waive or reduce underwriting. The catch is what happens when you leave the job — check whether you can convert to a personal policy on the same terms, because if you cannot, you will be underwritten fresh at whatever age and health you have then.
Keep reading
This page is general information about how insurance works in New Zealand. It is not regulated financial advice and it does not take your situation into account. For advice about your own cover, talk to a licensed financial adviser.