Specialist Consultations & Diagnostics — NZ Health Insurance
Specialist consultations and diagnostic imaging are usually covered via separate annual sublimits within a comprehensive plan — and not covered at all under hospital-only plans. The directory below shows each insurer's specialist + diagnostic limits.
Key considerations
- › Specialist Consultation sublimit ($N/year) is the cap on outpatient specialist visits before hospital admission.
- › Diagnostic Imaging sublimit covers MRI / CT / ultrasound / X-ray outside of an admission.
- › GP referral is generally required before the policy pays a specialist — affiliated provider rules apply.
- › Hospital-only plans exclude specialist consultations entirely.
Active retail products
These are the 23 active retail health insurance products available in NZ — the same set that applies regardless of profession or audience.
AA Health Everyday Cover
Wording effective 2026-05-16
- dental $450
- eye care $200
- gp and prescriptions $150
KidSmart
Wording effective 2026-05-16
- oral surgery $300,000
- mental health $1,000
- general surgery $500,000
KiwiCare
Wording effective 2026-04-01
- chemotherapy base $48,000
- chemotherapy 100 upgrade $100,000
- specialist consultation $4,000
ParentStay
Wording effective 2025-10-01
- cancer care $100,000
- mental health $1,000
- return of remains $50,000
AA Private Hospital Cover
Wording effective 2023-10-01
- surgical $300,000
- non surgical $200,000
- physiotherapy $750
AA Private Hospital + Specialist Cover
Wording effective 2026-05-16
- surgical benefit $300,000
- non surgical benefit $200,000
- gp surgery $750
RegularCare
Wording effective 2026-04-01
- chemotherapy base $48,000
- chemotherapy 100 upgrade $100,000
- specialist consultation $4,000
SmartCare
Wording effective 2026-05-16
- specialist consultation $5,000
- gp visit $55
- home nursing $6,000
SmartCare+
Wording effective 2026-05-16
- specialist consultation $5,000
- gp visit $55
- dental cover $500
SmartStay
Wording effective 2026-05-16
- oral surgery $150,000
- general surgery $150,000
- ct scans per year $2,500
StaffCare
Wording effective 2026-05-16
- ct scan $2,500
- mri scan $3,000
- pet scan $2,500
StaffCare+
Wording effective 2026-05-16
- gp visit $55
- oral surgery $300,000
- general surgery $300,000
UltraCare
Wording effective 2026-04-01
- chemotherapy base $60,000
- chemotherapy 100 upgrade $100,000
- specialist consultation $10,000
UniCare Advantage
Wording effective 2025-08-01
- specialist consultation $4,000
- psychiatric hospitalisation $3,500
- ambulance $160
Wellbeing Modules
Wording effective 2026-04-01
- physiotherapy $300
- body care podiatry $250
- day to day gp per visit $65
Wellbeing One
Wording effective 2026-04-01
- chemotherapy base $60,000
- chemotherapy 100 upgrade $100,000
- specialist consultation $5,000
Wellbeing Two
Wording effective 2026-04-01
- chemotherapy base $60,000
- chemotherapy 100 upgrade $100,000
- specialist consultation $5,000
Machine-readable API
- Every product:
/api/product/{insurer}/{product}/facts.json - Topic comparisons:
/api/topic/{slug}/summary.md - Anonymous MCP:
POST /mcp
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