{ "vertical": "health", "insurer": { "slug": "nib", "name": "nib", "brand_family": "nib" }, "product": { "slug": "easy-health", "name": "Easy Health", "status": "active", "positioning_summary": null }, "wording": { "version": "2024-09-20", "ingested_at": "2026-05-16T08:28:11.390687+00:00", "pdf_hash": "a5e1d5fcf45f524c6b1b918776fbcea7c3c735a92167a886a9effb684fce8260", "source_url": "https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.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 Reproductive Health category. The High-Risk Pregnancy Benefit specifically states that IVF is not 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)", "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 reductions", "Gynaecomastia", "Mastopexy", "assisted reproduction", "childbirth including caesarean sections", "hormone therapy", "infertility", "normal pregnancy, including termination of", "contraception", "erectile dysfunction", "sterilisation or reversal of sterilisation", "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)", "gene therapy", "genetic testing", "genetic conditions, in the absence of signs or symptoms that a condition exists at your join date", "concerns of familial risk or familial predisposition, in the absence of signs or symptoms that a condition exists", "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", "myopia, hypermetropia, presbyopia, radial keratotomy, and photo-refractive keratectomy", "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", "pre-existing conditions (unless the condition was declared at application and was accepted by us)", "any form of risk management (for example: screening, preventative, or prophylactic health services)", "health surveillance testing", "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", "services provided by someone who is not recognised by the Medical Council of New Zealand", "additional surgery or treatment that isn't covered under 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)", "substance misuse (for example: misuse of alcohol or drugs)", "dementia" ], "sublimits_nzd": { "gp_surgery": 1500, "foot_surgery": 6000, "eye_injections": 3000, "funeral_support": 5000, "loyalty_check_up": 100, "surgical_benefit": 300000, "overseas_treatment": 20000, "high_risk_pregnancy": 2000, "home_care_daily_max": 150, "skin_lesion_surgery": 6000, "home_care_annual_max": 6000, "medical_misadventure": 30000, "non_surgical_benefit": 200000, "sterilisation_loyalty": 1000, "proactive_health_screening": 750, "non_pharmac_cancer_treatment": 20000, "proactive_health_stay_active": 100, "public_hospital_payment_nightly": 300, "parent_accommodation_nightly_max": 200, "travel_and_accommodation_surgery": 3000, "physiotherapy_per_hospitalisation": 750, "public_hospital_payment_annual_max": 3000, "therapeutic_care_per_hospitalisation": 250, "travel_and_accommodation_nightly_max": 300, "proactive_health_allergy_vaccinations": 100, "proactive_health_loyalty_health_check": 150, "follow_up_investigations_cancer_annual": 3000, "proactive_health_dietitian_nutritionist": 300, "parent_accommodation_per_hospitalisation": 3000 }, "gap_payment_rules": "If you choose a recognised provider that is part of the First Choice Network, nib covers 100% of eligible costs up to the benefit limit, less any excess. If you choose a recognised provider that is not part of the First Choice Network, a gap payment may apply — the gap payment is the difference between what the provider charges and the Efficient Market Price (the maximum nib will pay for a service by a non-First Choice provider). The Efficient Market Price is determined based on what healthcare providers charge, nib's claims data, and nib's experience with New Zealand's health market. If a pre-approval was obtained, the Efficient Market Price at the pre-approval date applies; if not, the Efficient Market Price at the treatment date applies. The excess (chosen by the policyowner) applies once per insured person per policy year for any accepted claim and must be paid directly to the recognised provider along with any gap payments.", "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: pre-existing cardiovascular conditions (including congenital or acquired conditions, or conditions where specified risk factors applied at start/join date); pre-existing cancers (pre-malignant pre-existing cancers may be covered if there has been appropriate specialist/GP treatment); pre-existing hip or knee conditions (including degenerative conditions, disease, or injury); pre-existing back conditions (including spinal cord, vertebrae, soft tissues, and joints of the spine, and previous back surgery); transplant surgery (and any follow-up or complications); reconstructive or reparative surgery performed before the join date (including repairing scars and treating complications). If a dependent child is added within four months of birth, their pre-existing conditions are covered under Base Cover (general exclusions including congenital conditions still apply).", "acc_interaction_rules": "Injuries covered by ACC are a general exclusion and are not covered under this policy. The ACC Top-Up Benefit covers the difference if 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 Cover in Australia Benefit excludes surgery or treatment relating to an injury which would be covered under ACC if it had happened in New Zealand. If nib believes ACC should pay for a health service rather than nib, nib may ask ACC to review their decision on the policyholder's behalf, requiring full cooperation including granting legal authority, providing case summaries and ACC decline letters, and other relevant information. The Public Hospital Payment benefit does not cover any admission related to an acute condition.", "mental_health_sublimit_nzd": "Not covered — psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are a general exclusion with no sublimit provided.", "mental_health_admission_rules": "Psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) and injuries that are self-inflicted are general exclusions under this policy. There is no inpatient mental health admission benefit.", "oncology_high_cost_drugs_cover": "The Non-PHARMAC Cancer Treatment Benefit (Base Cover) pays for chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC at time of treatment and are Medsafe-approved, up to $20,000 per insured person per policy year, deducted from the overall Non-Surgical Benefit limit. Medicines administered or charged in a public hospital, and non-Medsafe-approved medicines, are excluded. The Non-PHARMAC Plus Option (if selected) provides additional cover for Medsafe-approved, non-PHARMAC-funded medicines (including those used at home for up to six months post-admission for approved treatment), up to the Option benefit limit per policy year, with 100% of eligible costs covered and no excess. No specific mention of Keytruda by name in the policy text.", "pharmac_vs_non_pharmac_drug_rules": "Medications must be registered and approved by Medsafe, prescribed and administered within Medsafe guidelines, prescribed by the treating specialist or GP, and funded by PHARMAC for the treatment needed at the time of treatment. If the cost is not fully funded by PHARMAC but meets these criteria, nib pays the difference up to the relevant benefit limit. Medications not funded by PHARMAC are generally excluded. The Non-PHARMAC Cancer Treatment Benefit covers chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC at time of treatment and are Medsafe-approved, up to $20,000 per insured person per policy year (deducted from overall benefit limit); medicines administered or charged in a public hospital and non-Medsafe-approved medicines are excluded under this benefit. The Non-PHARMAC Plus Option (if selected) covers Medsafe-approved medicines not funded by PHARMAC, used in a private hospital or at home for up to six months post-admission for approved treatment, up to the benefit limit per policy year; no excess applies; hospital services are not covered under this Option. Medications issued solely for home use (unless covered under a specific benefit), prescribed in a public hospital, or used for a purpose not funded by PHARMAC are not covered." }, "endpoints": { "summary": "/api/product/nib/easy-health/summary.md", "wording": "/api/product/nib/easy-health/wording.md", "history": "/api/product/nib/easy-health/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/nib/easy-health/facts.json", "generated_at": "2026-05-16T12:53:02.508Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }