{
  "vertical": "health",
  "insurer": {
    "slug": "aia",
    "name": "AIA",
    "brand_family": "aia"
  },
  "product": {
    "slug": "private-health",
    "name": "AIA Private Health",
    "status": "active",
    "positioning_summary": null
  },
  "wording": {
    "version": "2026-05-16",
    "ingested_at": "2026-05-16T08:32:00.580513+00:00",
    "pdf_hash": "cae5dfb774753f60ebc0b4cf41ddad5539261e92b947aed71899a4b70845de21",
    "source_url": "https://www.aia.co.nz/content/dam/nz/en/docs/our-products/policy-wordings/health/aia-private-health-umbrella-policy-wording.pdf",
    "page_count": null
  },
  "confidence_tier": "verified",
  "facts": {
    "ivf_cover": "Infertility treatment is excluded under AIA Private Health Cover: 'Diagnosis, management and treatment of infertility except as specifically provided by the pregnancy, maternity and infertility benefit under AIA Private Health Plus.' Under AIA Private Health Plus, the Pregnancy, Maternity and Infertility Allowance covers 'obstetric care (including scans), infertility diagnosis and treatment carried out by a registered medical practitioner or a specialist at an approved facility,' up to $1,500 per pregnancy, per life assured, per policy year, available only after two years of continuous cover under AIA Private Health Plus. No excess applies. IVF is not explicitly named but infertility treatment is covered under the Plus tier within these limits.",
    "exclusions": [
      "Any accommodation, flight and/or transport, except where expressly covered by a benefit in this policy.",
      "Care provided for a sign, symptom, condition or disease that requires immediate or same day hospital admission for treatment or monitoring.",
      "Any additional surgery performed during an operation, which is not directly related to the medical condition or treatment for which cover is claimed under the terms of this policy.",
      "Any treatment by a physiotherapist, chiropractor, osteopath, naturopath, homeopath, acupuncturist, podiatrist, dietitian, counsellor or speech therapist except where expressly covered by a benefit in this policy.",
      "Bariatric surgery for any condition including but not limited to obesity, diabetes and sleep apnoea, except where expressly covered by a benefit in this policy.",
      "Breast reduction surgery (except where expressly covered under a benefit in this policy) and gynaecomastia.",
      "Circumcision except where medically necessary.",
      "Any congenital condition except where expressly covered under the Congenital Condition Surgery Benefit in this policy.",
      "Contraception of any type.",
      "Any elective or cosmetic procedure or any surgery, procedure or treatment that improves, alters or enhances appearance, whether or not undertaken for medical, physical, functional, psychological or emotional reasons.",
      "Any injury or condition arising from participation in a criminal activity.",
      "Dental repair or implants, orthodontic treatment, orthognathic, periodontal, or endodontic procedures, implants and related surgery of any kind except where expressly covered under a benefit in this policy.",
      "The misuse of prescribed or non-prescribed drugs, including where they have not been taken in accordance with the manufacturer's or registered medical practitioner's directions.",
      "Any appliances, aids, implants or equipment including but not limited to implantable defibrillators, nerve appliances, hearing aids, cochlear implants, braces, crutches, mouth-guards, orthotics, insulin pumps, CPAP machines and any other appliances or equipment (surgical, medical or dental) except cardiac pacemakers, implantable loop recorders or where expressly covered under a benefit in this policy.",
      "Any injury, illness, condition or disability arising from, caused or contributed by, drug taking, intoxication or misuse of alcohol.",
      "Diagnosis, management and treatment of infertility except as specifically provided by the pregnancy, maternity and infertility benefit under AIA Private Health Plus.",
      "Psychiatric, psychological and/or neurodevelopment disorders including treatment or counselling for but not limited to pre-senile dementia, senile illness or dementia, geriatric care including geriatric in-patient care and disability support services, intellectual disability (intellectual development disorder), autism spectrum disorder, attention deficit/hyperactivity disorder, specific learning disorders, motor disorders (including but not limited to Tourette's disorder) or dyslexia.",
      "New medical treatments and procedures including any prescription drugs, medical devices, treatment techniques and/or procedures, tests and/or other healthcare services that have not been approved by AIA in its sole discretion.",
      "Drugs required for your particular treatment that are not subsidised by Pharmac, except for the drugs required for the chemotherapy benefit under Cancer Care in AIA Private Health Cover.",
      "Any injury, illness, condition or disability arising from nuclear contamination.",
      "Nursing care, except where expressly covered under a benefit in this policy.",
      "Treatment of obesity (including treatment of complications arising from any treatment for obesity; any disease or disorder of the skin or psychological treatment), except where expressly covered by a benefit in this policy.",
      "Obstetric visits, pregnancy, childbirth or any associated conditions or complications except as specifically provided by the obstetric care allowance or, the pregnancy, maternity and infertility benefit under AIA Private Health Plus.",
      "Organ donation and receipt.",
      "Treatments or procedures not provided by a registered medical practitioner practising within his or her scope of practice except where expressly covered under a benefit in this policy.",
      "Palliative care, except where expressly covered by a benefit in this policy.",
      "Any pre-existing condition, unless the symptom or condition was disclosed to AIA at the time of your application and accepted as covered by AIA in writing.",
      "Prescriptions, except where expressly covered by a benefit in this policy.",
      "Preventative treatment, health surveillance screening or treatment or investigation (including as a result of family history) where the life assured has no medical symptoms or where the condition will not cause significant problems for the health of the life assured."
    ],
    "sublimits_nzd": {
      "minor_surgery": 3000,
      "translation_costs": 500,
      "ambulance_transfer": 200,
      "cancer_care_overall": 500000,
      "home_nursing_per_day": 300,
      "medical_hospitalisation": 500000,
      "obstetric_care_allowance": 2000,
      "bereavement_grant_lifetime": 3500,
      "home_nursing_per_policy_year": 5000,
      "sterilisation_life_of_policy": 5000,
      "medical_misadventure_lifetime": 30000,
      "mental_health_support_benefit": 2500,
      "specialist_consultations_plus": 10000,
      "health_screening_allowance_plus": 500,
      "diagnostic_imaging_and_tests_plus": 100000,
      "major_diagnostic_imaging_and_tests": 200000,
      "parents_grieving_benefit_per_child": 2000,
      "public_hospital_cash_grant_per_day": 300,
      "congenital_conditions_surgery_lifetime": 2000,
      "post_cancer_treatment_care_and_support": 1000,
      "treatment_overseas_not_available_in_nz": 30000,
      "palliative_hospice_respite_care_lifetime": 1500,
      "public_hospital_cash_grant_per_policy_year": 3000,
      "pregnancy_maternity_infertility_allowance_plus": 1500,
      "health_screening_allowance_vitality_member_plus": 750,
      "dental_evaluation_prior_to_qualifying_treatments": 1500,
      "treatment_away_from_home_accommodation_daily_sublimit": 300,
      "public_hospital_cancer_treatment_cash_benefit_lifetime": 5000,
      "treatment_away_from_home_nz_and_parent_accommodation_combined": 3000,
      "bariatric_surgery_and_bilateral_breast_reduction_combined_lifetime": 7500
    },
    "gap_payment_rules": "AIA will pay the health service provider directly upon receipt of the invoice or statement up to the maximum cover. The excess and any costs that are not covered (including costs exceeding the maximum cover) must be paid directly by the policy owner to the health service provider. AIA pays only up to the reasonable charges; if the proposed cost exceeds reasonable charges, the policy owner is responsible for the difference regardless of the maximum cover. If treatment is provided by an AIA Healthcare Partnership Programme provider, no prior approval or claims information is needed from the policy owner — the provider bills AIA directly and advises the policy owner of any costs they must pay (e.g. excess, costs not covered, or costs exceeding maximum cover). For treatment outside Australia under the Voluntary Treatment Overseas benefit, AIA pays 85% of the reasonable charges.",
    "excess_amounts_nzd": [
      0,
      250,
      500,
      750,
      1000,
      2000,
      4000,
      10000
    ],
    "pre_existing_rules": "Any pre-existing condition is excluded unless the symptom or condition was disclosed to AIA at the time of your application and accepted as covered by AIA in writing. If a life assured fails to disclose material information to AIA prior to inception, variation or reinstatement of the policy, or has made a substantially incorrect statement on the faith of which the policy was issued, AIA may avoid the policy from inception, alter the terms of cover, or remove the life assured from cover.",
    "waiting_periods_days": {},
    "acc_interaction_rules": "This policy does not cover any costs arising from treatments or procedures for accidents or injuries including treatment injuries (medical misadventure) that ACC is legally responsible to pay. The life assured must submit any accident-related claim to ACC first, and must obtain prior approval from ACC before incurring private treatment costs. When ACC agrees to contribute, AIA may cover additional costs up to the reasonable charges or maximum cover of this policy (prior approval from AIA required). If ACC declines, AIA reserves the right to require the life assured to apply to ACC for a review before AIA considers the claim. If ACC upholds a decline, AIA may cover costs up to the reasonable charges or maximum cover (prior approval required). AIA will not pay for any MRI or CT scans or other specialised imaging procedures recommended by a registered medical practitioner within seven days of an accidental injury claim being lodged with ACC. If ACC does not cover the claim due to the policy owner's or life assured's failure to properly make a claim with ACC or comply with ACC's claims requirements, AIA will deem the life assured has not made reasonable efforts to secure cover with ACC and so is not able to claim under this policy.",
    "mental_health_sublimit_nzd": 2500,
    "mental_health_admission_rules": "Mental illness is broadly excluded: 'Psychiatric, psychological and/or neurodevelopment disorders including treatment or counselling for but not limited to pre-senile dementia, senile illness or dementia, geriatric care including geriatric in-patient care and disability support services, intellectual disability (intellectual development disorder), autism spectrum disorder, attention deficit/hyperactivity disorder, specific learning disorders, motor disorders (including but not limited to Tourette's disorder) or dyslexia.' The only mental health cover provided is the Mental Health Support Benefit ($2,500 per life assured per policy year), which covers the cost of a Psychiatrist or Psychologist consultation and/or counselling where the support treatment and/or consultations directly relate to a claim under the Surgery or Cancer Care benefits, received within six months of the claim being accepted. No excess applies to this benefit.",
    "oncology_high_cost_drugs_cover": "Under the Cancer Care benefit, the policy covers 'the cost of Pharmac and non-Pharmac subsidised MedSafe indicated cancer chemotherapy and immunotherapy drugs, subject to AIA criteria,' including targeted therapy, oral, intravenous infusion, instilled, and intraoperative chemotherapy provided by or under the direction of a specialist, whether administered in an approved facility or at home. Prior approval must be obtained before treatment takes place. The overall Cancer Care benefit maximum is $500,000 per life assured per policy year.",
    "pharmac_vs_non_pharmac_drug_rules": "Non-Pharmac subsidised drugs are excluded generally: 'Drugs required for your particular treatment that are not subsidised by Pharmac, except for the drugs required for the chemotherapy benefit under Cancer Care in AIA Private Health Cover.' Under Cancer Care, the policy covers 'the cost of Pharmac and non-Pharmac subsidised MedSafe indicated cancer chemotherapy and immunotherapy drugs, subject to AIA criteria.' No specific mention of Keytruda by name."
  },
  "endpoints": {
    "summary": "/api/product/aia/private-health/summary.md",
    "wording": "/api/product/aia/private-health/wording.md",
    "history": "/api/product/aia/private-health/history.json"
  },
  "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/aia/private-health/facts.json",
  "generated_at": "2026-05-16T12:53:09.237Z",
  "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz"
}