{ "vertical": "health", "insurer": { "slug": "nib", "name": "nib", "brand_family": "nib" }, "product": { "slug": "ultimate-health", "name": "Ultimate Health", "status": "active", "positioning_summary": null }, "wording": { "version": "2025-11-24", "ingested_at": "2026-05-16T08:20:59.120245+00:00", "pdf_hash": "4a248a5ade8336996f57ff21393b2eefd87516f4cbb6a5431f7432ee56408c06", "source_url": "https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf", "page_count": null }, "confidence_tier": "inferred", "facts": { "ivf_cover": "IVF is not covered. Assisted reproduction is listed as a general exclusion under Reproductive Health. The High-Risk Pregnancy Benefit explicitly states 'we don't consider IVF to be a risk factor' and infertility is also excluded.", "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 or genetic conditions, in the absence of signs or symptoms that a condition exists from your join date", "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" ], "sublimits_nzd": { "dental": 500, "gp_surgery": 1500, "stay_active": 100, "foot_surgery": 6000, "eye_injections": 3000, "funeral_support": 5000, "osteopath_xrays": 80, "sports_physician": 500, "surgical_benefit": 600000, "therapeutic_care": 1000, "home_care_per_day": 300, "screening_benefit": 750, "chiropractor_xrays": 80, "overseas_treatment": 30000, "foot_care_per_visit": 40, "high_risk_pregnancy": 2000, "osteopath_acc_visit": 15, "osteopath_per_visit": 40, "skin_lesion_surgery": 6000, "foot_care_annual_max": 250, "gp_home_consultation": 80, "health_check_loyalty": 150, "home_care_annual_max": 6000, "medical_misadventure": 30000, "non_surgical_benefit": 300000, "osteopath_annual_max": 250, "acupuncture_acc_visit": 15, "acupuncture_per_visit": 40, "sterilisation_loyalty": 1000, "acupuncture_annual_max": 250, "cardiac_investigations": 60000, "chiropractor_acc_visit": 15, "chiropractor_per_visit": 40, "dietitian_nutritionist": 300, "prescriptions_per_item": 15, "chiropractor_annual_max": 250, "gp_surgery_per_procedure": 200, "prescriptions_annual_max": 300, "ear_care_audiometric_tests": 250, "gp_acc_top_up_consultation": 25, "gp_consultations_per_visit": 55, "eye_care_eyewear_annual_max": 330, "physiotherapy_acc_treatment": 15, "non_pharmac_cancer_treatment": 20000, "nurse_practitioner_per_visit": 30, "ear_care_audiology_treatments": 250, "parent_accommodation_per_night": 300, "follow_up_investigations_cancer": 3000, "parent_accommodation_annual_max": 3000, "travel_for_surgery_or_treatment": 3000, "allergy_testing_and_vaccinations": 100, "eye_care_consultations_per_visit": 55, "specialist_consultations_benefit": "80% of eligible costs, unlimited consultations (Specialist Option)", "eye_care_consultations_annual_max": 275, "diagnostic_tests_specialist_option": 3000, "gp_consultations_annual_max_visits": 12, "physiotherapy_gp_option_annual_max": 400, "travel_and_accommodation_per_night": 300, "nurse_practitioner_annual_max_visits": 6, "physiotherapy_gp_option_per_treatment": 40, "speech_occupation_eye_therapy_per_visit": 40, "speech_occupation_eye_therapy_annual_max": 300 }, "gap_payment_rules": "The policy pays 80% or 100% of eligible costs depending on the benefit and whether the diagnostic investigation is listed on the Diagnostics Schedule. For benefits paying 80%, the insured person bears the remaining 20% co-payment. For benefits listed on the Diagnostics Schedule, 100% of eligible costs are paid up to the available benefit limit. The Specialist Option pays 80% of eligible costs for specialist consultations and diagnostic tests. No explicit gap payment arrangement between nib and providers (such as a no-gap or known-gap scheme) is described in this document.", "pre_existing_rules": "Personal exclusions (usually pre-existing conditions) are listed on the Acceptance or Renewal Certificate and are not covered. For the Specialist Option and GP Option and Dental, Optical, and Therapeutic Option, if a dependent child is added within four months of birth, their pre-existing conditions are covered under those Options except for congenital conditions. Hereditary or genetic conditions are excluded in the absence of signs or symptoms that a condition exists from your join date. The Acceptance or Renewal Certificate may also include loadings for specific health risks.", "acc_interaction_rules": "Injuries that are covered by ACC are excluded from cover. The ACC Top-Up Benefit pays the difference if ACC claim payments don't 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 the ACC Top-Up Benefit. The ACC Treatment Injury Benefit covers surgery or treatment needed to treat or repair an injury sustained during a health service paid for by nib, to the extent not covered by ACC, up to the remaining Surgical or Non-Surgical Benefit limit. If nib has paid for treatment and ACC reimburses the insured person, the reimbursement must be forwarded to nib.", "mental_health_sublimit_nzd": "psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are excluded entirely — no sublimit applies as these conditions are not covered", "mental_health_admission_rules": "Psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are listed as a general exclusion. There is no inpatient mental health admission benefit under this policy.", "oncology_high_cost_drugs_cover": "Non-PHARMAC Cancer Treatment Benefit: covers chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC at the time of treatment, up to $20,000 per insured person every policy year, deducted from the overall benefit limit. Medicines administered or charged in a public hospital are excluded. Medicines not approved by Medsafe are excluded.", "pharmac_vs_non_pharmac_drug_rules": "Cancer Treatment Benefit covers medications administered in a private hospital as part of chemotherapy, immunotherapy, radiotherapy or brachytherapy up to the Non-Surgical Benefit limit. The Non-PHARMAC Cancer Treatment Benefit separately covers chemotherapy or immunotherapy medicines administered in a private hospital that are not funded by PHARMAC at the time of treatment, up to $20,000 per insured person every policy year (deducted from the overall benefit limit). Medicines administered or charged in a public hospital are not covered under the Non-PHARMAC benefit, nor are medicines not approved by Medsafe." }, "endpoints": { "summary": "/api/product/nib/ultimate-health/summary.md", "wording": "/api/product/nib/ultimate-health/wording.md", "history": "/api/product/nib/ultimate-health/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/nib/ultimate-health/facts.json", "generated_at": "2026-05-16T12:53:18.386Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }