What is health insurance in New Zealand? — A plain-English guide
Private health insurance in New Zealand is the thing that pays for care you'd otherwise wait for in the public Te Whatu Ora system, or pay out-of-pocket privately. This guide walks through what private cover does and doesn't do, the three rough plan tiers, and how to read a NZ policy wording so the sublimits don't surprise you at claim time.
Key considerations
- › Public vs private — the public system funds emergency, urgent and clinically-prioritised planned care. Private cover is what gets you ahead of the queue for elective surgery, more choice of specialist, and a private hospital room.
- › Hospital-only plans (e.g. nib Easy Health, SX RegularCare/KiwiCare) carry lower premiums but exclude day-to-day care.
- › Comprehensive plans (e.g. SX Wellbeing One/Two, nib Ultimate Health Max) add specialist consultations, diagnostics and sometimes GP cover.
- › Modular plans (SX Wellbeing + Modules) let you add day-to-day, vision/dental, wellness as separate paid modules.
- › Pharmac vs non-Pharmac drug cover is the biggest differentiator on oncology — see /topics/pharmac-vs-non-pharmac/.
- › How to read a wording: focus on the per-procedure sublimit, the annual maximum, the excess, the pre-existing-condition rules, and the waiting periods.
Relevant deep dives
- Pharmac vs non-Pharmac drug coverNZ's Pharmac funds a defined list of medicines. Non-Pharmac drugs (including high-cost can…
- Gap payment rulesWhen a provider's charges exceed what the insurer pays, the member pays the 'gap'. NZ insu…
- Pre-existing conditionsNZ health insurers handle pre-existing conditions in two main ways: (1) disclose-and-accep…
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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