{ "vertical": "health", "insurer": { "slug": "aa", "name": "AA Health", "brand_family": "aa" }, "product": { "slug": "private-hospital-specialist-cover", "name": "AA Private Hospital + Specialist Cover", "status": "active", "positioning_summary": null }, "wording": { "version": "2026-05-16", "ingested_at": "2026-05-16T13:40:20.80538+00:00", "pdf_hash": "041cb76a8be3821243510674ce8129f32453b38349d6e4e5b137a171eaeab749", "source_url": "https://www.aa.co.nz/content/dam/nzaa/02-services/insurance/health-insurance/policy-wordings/6104871.PDF", "page_count": null }, "confidence_tier": "inferred", "facts": { "ivf_cover": "IVF is not covered. Assisted reproduction and infertility are listed as general exclusions. Under the High-Risk Pregnancy Benefit, IVF is explicitly stated not to be considered a risk factor.", "exclusions": [ "anything cosmetic or reconstructive that is not medically necessary regardless of whether it's done for physical, functional, psychological, or 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 committed 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", "services provided by a family member (for example: health services, travel costs, or accommodation)", "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)", "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": { "gp_surgery": 750, "eye_injections": 3000, "surgical_benefit": 300000, "home_care_per_day": 150, "high_risk_pregnancy": 2000, "skin_lesion_surgery": 6000, "non_surgical_benefit": 200000, "sterilisation_loyalty": 1000, "cancer_treatment_at_home": 10000, "home_care_per_policy_year": 6000, "physiotherapy_post_hospital": 750, "parent_accommodation_per_night": 200, "therapeutic_care_post_hospital": 250, "non_pharmac_cancer_treatment_base": 10000, "travel_and_accommodation_per_night": 300, "travel_for_surgery_per_policy_year": 3000, "follow_up_investigations_for_cancer": 3000, "parent_accommodation_per_policy_year": 3000, "ct_mri_pet_scans_not_related_to_admission": 5000, "diagnostic_tests_not_related_to_admission": 15000 }, "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 — this is the difference between what the provider charges and the Efficient Market Price (the maximum nib will pay for that service). The Efficient Market Price is determined by nib based on what healthcare providers charge, nib's claims data, and experience with the New Zealand health market. If pre-approval was obtained, the Efficient Market Price at the pre-approval date applies; without pre-approval, the Efficient Market Price at the treatment date applies. nib may change the Efficient Market Price at its discretion. The excess is paid directly to the recognised provider along with any gap payments and other uncovered costs.", "pre_existing_rules": "A pre-existing condition is 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 the join date, no claims that directly or indirectly relate to any pre-existing conditions will be paid. After three years of continuous cover following the join date, eligible pre-existing conditions are covered. Some pre-existing conditions are never covered, including: pre-existing congenital or acquired cardiovascular conditions (with additional risk-factor exclusions for diabetes, hypercholesterolaemia, BMI ≥30); pre-existing cancers (with limited exceptions for certain pre-malignant conditions that have had appropriate treatment); pre-existing hip or knee conditions including degenerative conditions, disease or injury; pre-existing back conditions including any condition of or injury to the back; transplant surgery; and reconstructive or reparative surgery performed before the join date. A dependent child added within four months of birth has pre-existing conditions covered under Base Cover (congenital condition exclusions still apply).", "waiting_periods_days": { "pre_existing": 1095 }, "acc_interaction_rules": "Injuries covered by ACC are generally excluded. The ACC Top-Up Benefit pays the difference where ACC claim payments do not fully cover the cost of surgery or medical treatment for a physical injury, up to the benefit limit remaining on the Surgical or Non-Surgical Benefit; injuries that occurred before the join date are not covered under this benefit. The ACC Treatment Injury Benefit covers surgery or treatment needed to treat or repair an injury sustained during a health service that nib has paid for, where that injury is not covered by ACC, up to the benefit limit remaining on the Surgical or Non-Surgical Benefit; evidence of an ACC treatment injury claim submission is required. If ACC declines to pay, nib may request an ACC review on the insured person's behalf. If nib has paid for treatment and ACC subsequently reimburses the insured person, that money must be forwarded to nib. Acute medical conditions and acute care are excluded. If nib believes ACC should pay for a health service, nib may ask ACC to review their decision.", "mental_health_sublimit_nzd": "Not covered — psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are excluded entirely.", "mental_health_admission_rules": "Inpatient mental health admissions are not covered. Psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are excluded under the general exclusions.", "oncology_high_cost_drugs_cover": "Under the base Non-PHARMAC Cancer Treatment Benefit, chemotherapy or immunotherapy medicines administered in a private hospital that are not PHARMAC-funded are covered up to $10,000 per insured person per policy year (deducted from the Non-Surgical Benefit limit); Medsafe approval required. The optional Non-PHARMAC Plus Benefit covers non-PHARMAC, Medsafe-approved medicines (including high-cost cancer drugs) used in a private hospital or at home for up to six months post-admission, up to the selected benefit limit per insured person per policy year, with no excess; requires specialist referral and a recommendation letter explaining reasons for prescribing.", "pharmac_vs_non_pharmac_drug_rules": "Medications claimed under the policy must be funded by PHARMAC for the treatment needed at the time of treatment (unless a specific benefit or Option covers non-PHARMAC medicines). If the cost of medication is not fully funded by PHARMAC but meets all criteria, the policy pays the difference up to the relevant benefit limit. Under the base Non-PHARMAC Cancer Treatment Benefit, chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC are covered up to $10,000 per insured person per policy year, provided the medicines are approved by Medsafe; medicines administered or charged in a public hospital and medicines not approved by Medsafe are excluded. The Cancer Treatment at Home Benefit covers PHARMAC-funded chemotherapy medicines prescribed for use at home, up to $10,000 per insured person per policy year. The optional Non-PHARMAC Plus Benefit covers Medsafe-approved medicines not funded by PHARMAC, used in a private hospital or at home for up to six months post-admission, up to the benefit limit selected, with no excess required; medicines must be referred by a specialist and relate to an accepted claim under the Surgical, Non-Surgical, or Cancer Treatment Benefit." }, "endpoints": { "summary": "/api/product/aa/private-hospital-specialist-cover/summary.md", "wording": "/api/product/aa/private-hospital-specialist-cover/wording.md", "history": "/api/product/aa/private-hospital-specialist-cover/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/aa/private-hospital-specialist-cover/facts.json", "generated_at": "2026-05-18T11:58:05.874Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }