Why get health insurance?

Public vs. private healthcare

When deciding on whether to get health insurance, it’s helpful to understand how the New Zealand health system works. 

How private health insurance works with the public healthcare system and ACC

The New Zealand public healthcare system provides cover for all New Zealand residents for acute care and some elective services.

• Acute care is provided in response to a sign, symptom, condition, or disease that needs immediate treatment or monitoring. This may include urgent care required for an illness with sudden onset – such as appendicitis or heart attack. 
• Elective services are planned medical and surgical services that don’t need to be done right away. To receive these services under the public health system, you need to meet certain criteria, and you are likely to go on a waiting list before you receive the service. Some services that are commonly provided on a planned basis include:
  
  
  • diagnostic services such as an MRI scan, endoscopy, or laparoscopy
  • tonsillectomy
  • grommets
  • hip or knee replacements
  • heart surgery
  • hysterectomy
  • cataract removal, and
  • cancerous tumour removal.

ACC provides no fault injury cover for everyone in New Zealand. This includes injuries at home, school, or work. For example, if you injure your back after falling down stairs at home, ACC should cover the treatment of your back injury as well as subsidising or paying for any subsequent support services, rehabilitation, and loss of income due to the injury.

Private health insurance is designed to complement the services provided through ACC and the New Zealand public healthcare system by reducing the longer waitlists which may be present in the public healthcare system for elective services, and get you back to health as quickly as possible.

This is why private health insurance does not usually provide cover for healthcare services related to:

• acute care, which is covered by the public healthcare system; or
• accidents, treatment injuries and work-related gradual process injuries that are covered by ACC.

In some cases, ACC will not pay the full amount charged for treatment. In these cases, health insurance may provide a top up for the shortfall if the healthcare service is covered under your policy.

Private health insurance does not generally provide cover for chronic conditions, such as spina bifida or cystic fibrosis. Cover for these conditions is usually provided by the public healthcare system.

Is it worth having private health insurance in New Zealand? 

Having private health insurance is a personal choice. Private health insurance is there to help get you back to health as quickly as possible by complementing the publicly funded services that are available to you. If you have a medical condition that doesn't need to be treated right away, you could have a long wait for diagnosis or treatment in the public health system which may affect your quality of life.  

If you pay for diagnostic or planned treatment services yourself, you can avoid public waiting lists and get diagnosed or treated sooner, but it may come with a hefty price tag.

With private health insurance, you can access healthcare faster and get help with the costs of that healthcare. This can improve your quality of life faster, with less financial worry.