{ "vertical": "health", "insurer": { "slug": "aa", "name": "AA Health", "brand_family": "aa" }, "product": { "slug": "private-hospital-cover", "name": "AA Private Hospital Cover", "status": "active", "positioning_summary": null }, "wording": { "version": "2023-10-01", "ingested_at": "2026-05-16T13:36:42.02954+00:00", "pdf_hash": "2368af34c2185b0c528923667a381abae678944c8d487aa639d627da19e9b9f5", "source_url": "https://www.aa.co.nz/content/dam/nzaa/02-services/insurance/health-insurance/policy-wordings/604920-11-1023-AAHPD-AA-Health-Insurance-Private-Hospital-Cover-Policy-Document-D10-WEBacc.pdf", "page_count": null }, "confidence_tier": "inferred", "facts": { "ivf_cover": "Excluded. Assisted reproduction and infertility are listed as general exclusions under the Reproductive Health category.", "exclusions": [ "anything cosmetic or reconstructive that is not medically necessary regardless of whether it's done for physical, functional, psychological, or for emotional reasons (for example: treatment that improves, changes, or enhances your appearance)", "Abdominoplasty, Hyperhidrosis, Rectus divarication repair", "weight loss or bariatric investigations or treatment (for example: gastric banding, sleeve, and bypass), even if the purpose is to treat other health conditions (for example: diabetes or cardiovascular conditions)", "breast implants", "breast reductions", "Gynaecomastia", "revision of breast reconstruction", "assisted reproduction", "childbirth including caesarean sections", "hormone therapy", "infertility", "intrauterine devices", "pregnancy (for example: normal pregnancy, ectopic, or termination of)", "contraception", "erectile dysfunction", "sterilisation or reversal of sterilisation", "any treatment or procedures that are related to gender dysphoria", "gender reassignment", "psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders)", "injuries that are self-inflicted", "congenital or chromosomal disorders (for example: a birth defect)", "congenital kyphosis, congenital scoliosis, cystic fibrosis, or pectus excavatum", "Marfan's syndrome", "gene therapy", "genetic testing", "hereditary conditions", "any acute medical conditions or acute care", "ambulance society subscriptions", "injuries that are covered by ACC", "aids that assist with rehabilitation and mobility (for example: crutches, toilet frames, artificial limbs)", "continuous care (for example: geriatric, palliative, rehabilitation)", "mechanical tools or appliances (for example: insulin pumps, CPAP machines and equipment, pacemakers)", "organ or tissue transplants or donations (for example: organ transplants)", "specialised transfusions (for example: transfusion of blood, blood products and derivatives, and dialysis of any type)", "dentures", "dental implants", "Orthognathic surgery", "Periodontics, orthodontics, and endodontic procedures", "tooth exposure", "vision enhancement and correction (for example: myopia, hypermetropia, presbyopia, astigmatism, or laser treatment)", "Blepharoplasty", "any treatment for a condition relating to crime commited by you", "conditions or treatment relating to wars, riots, or terrorism", "HIV or AIDS", "treatment for allergies or allergic disorders (for example: desensitisation or patch testing)", "medicines that aren't funded by PHARMAC under the latest PHARMAC Pharmaceutical Schedule", "conditions not registered with the Ministry of Health as a disease", "any form of risk management (for example: screening, preventative, or prophylactic health services)", "health services due to concerns of familial risk or familial predisposition, in the absence of signs or symptoms that a condition exists", "sleep problems or disorders (for example: snoring, insomnia, or sleep apnoea)", "alternative or complementary medicine or therapy (for example: homoeopathy and natural therapy)", "experimental, unproven, or unconventional treatments or procedures", "providers who don't meet our criteria", "health services provided by a family member (for example: health services, travel costs, or accommodation)", "health services provided by someone who is not recognised by the Medical Council of New Zealand", "technologies that we haven't approved that we consider novel or experimental or that are more expensive than an alternative treatment which will provide a similar outcome", "additional surgery or treatment that isn't covered under your policy", "claims that don't meet the terms of your policy", "expenses recoverable from a third party (for example: another insurer, company, or person)", "health services after the applicable benefit limit has been reached", "health services not covered under your policy", "anything that isn't medically necessary (for example: alcohol, toiletries, car parking, visitor meals, or administration costs)", "GP and out-of-hospital charges (including prescriptions)", "health services or goods that were received or purchased outside of New Zealand (for example: goods bought online from another country)", "false or inaccurate information provided for a policy application or claim request", "substance misuse (for example: misuse of alcohol or drugs)" ], "sublimits_nzd": { "surgical": 300000, "non_surgical": 200000, "physiotherapy": 750, "therapeutic_care": 250, "home_care_per_day": 150, "skin_lesion_surgery": 6000, "home_care_annual_max": 6000, "cancer_treatment_at_home": 10000, "non_pharmac_cancer_treatment": 10000, "parent_accommodation_per_night": 200, "parent_accommodation_annual_max": 3000, "travel_and_accommodation_per_night": 300, "follow_up_investigations_for_cancer": 3000, "travel_surgery_or_medical_treatment": 3000 }, "gap_payment_rules": "If a recognised provider is part of the First Choice Network, 100% of eligible costs are covered (up to the benefit limit, less any applicable excess) with no gap payment. If a recognised provider is not part of the First Choice Network, a gap payment may apply — the gap payment is the difference between what the non-First Choice recognised provider charges and the Efficient Market Price (the maximum the insurer will pay for that service). The Efficient Market Price is determined based on what healthcare providers charge for a particular health service, the insurer's claims data, and experience with New Zealand's national and regional health market. If pre-approval was obtained, the Efficient Market Price as at the pre-approval date applies; if no pre-approval, the Efficient Market Price as at the treatment date applies. The insurer can change the Efficient Market Price at its discretion. The insured must pay the excess directly to their recognised provider along with any costs not covered and any gap payments.", "pre_existing_rules": "Any sign, symptom, treatment, or surgery of any condition that happened on or before the insured person's join date that the policyowner(s) or another insured person were aware of, had an indication that something was wrong, sought investigation or medical advice for, or would cause a reasonable person to seek diagnosis, care, or treatment. In the first three years following your join date, we won't pay any claims that directly or indirectly relate to any pre-existing conditions. After three years of continuous cover, eligible pre-existing conditions are covered. Some pre-existing conditions are never covered, including: pre-existing congenital or acquired cardiovascular conditions (with additional carve-outs for certain diabetes/cholesterol risk factors); pre-existing cancers (with limited exceptions for certain pre-malignant cancers with appropriate prior treatment); pre-existing hip or knee conditions; pre-existing back conditions; any prior transplant surgery; and any prior reconstructive or reparative surgery. If a dependent child is added within four months of birth, their pre-existing conditions are covered under Base Cover (general and personal exclusions including congenital conditions still apply).", "waiting_periods_days": { "pre_existing": 1095 }, "acc_interaction_rules": "Injuries covered by ACC are excluded from Base Cover. The ACC Top-Up Benefit covers the difference between ACC claim payments and the actual cost of surgery or medical treatment for a physical injury, up to the remaining Surgical or Non-Surgical Benefit limit for the policy year. The ACC Treatment Injury Benefit covers surgery or treatment needed to treat or repair an injury sustained during a health service paid for by the insurer that is not covered by ACC; evidence of an ACC treatment injury claim being submitted to ACC is required; if ACC declines, the insurer may request an ACC review on the policyholder's behalf; if the insurer has paid and ACC subsequently reimburses the insured, the reimbursement must be forwarded to the insurer. If the insurer believes ACC should pay for a health service, it may ask ACC to review their decision on the insured's behalf, requiring full cooperation from the insured.", "mental_health_sublimit_nzd": "Not covered — mental health conditions are excluded", "mental_health_admission_rules": "Psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are excluded from cover. There is no inpatient mental health admission benefit under this policy.", "oncology_high_cost_drugs_cover": "Non-PHARMAC Cancer Treatment Benefit (Base Cover): covers chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC at the time of treatment, up to $10,000 per insured person per policy year, deducted from the overall benefit limit. Medicines must be Medsafe-approved and used within Medsafe approval; excludes medicines administered or charged in a public hospital and medicines not approved by Medsafe. Non-PHARMAC Plus Option (optional): covers non-PHARMAC, Medsafe-approved medicines (used within Medsafe approval) in a private hospital or at home for up to six months after a covered private hospital admission, up to the selected benefit limit per policy year; no excess applies to this Option; requires specialist referral and a recommendation letter from the specialist; must relate to an accepted claim under Surgical, Non-Surgical, or Cancer Treatment Benefit.", "pharmac_vs_non_pharmac_drug_rules": "Base Cover only covers medications that are funded by PHARMAC for the treatment needed at the time of treatment (and registered/approved by Medsafe, prescribed and administered within Medsafe guidelines, prescribed by the treating specialist or GP). If the cost of a PHARMAC-funded medication is not fully funded by PHARMAC, the policy pays the difference up to the relevant benefit limit. Non-PHARMAC medicines are generally excluded under Base Cover. Exceptions: (1) Non-PHARMAC Cancer Treatment Benefit covers chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC, up to $10,000 per insured person per policy year (must be Medsafe-approved and used within Medsafe approval). (2) Cancer Treatment at Home Benefit covers PHARMAC-funded chemotherapy medicines prescribed for home use, up to $10,000 per policy year. (3) The optional Non-PHARMAC Plus Benefit covers non-PHARMAC medicines (Medsafe-approved, used within Medsafe approval, not funded by PHARMAC) used in a private hospital or at home for up to six months after a covered private hospital admission, up to the selected benefit limit per policy year." }, "endpoints": { "summary": "/api/product/aa/private-hospital-cover/summary.md", "wording": "/api/product/aa/private-hospital-cover/wording.md", "history": "/api/product/aa/private-hospital-cover/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/aa/private-hospital-cover/facts.json", "generated_at": "2026-05-18T11:58:05.258Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }