NZ Health Insurance Terminology Glossary
Key NZ health insurance terminology. Each term links to the relevant deep dive in our verified data layer where the real numbers + verbatim wording sit.
Key considerations
- › Excess: the per-claim amount you pay out-of-pocket before the insurer covers the rest. See /health-insurance-excess-guide-nz/.
- › Sublimit: a separate annual cap inside the overall benefit limit (e.g. $5,000 specialist consultations within $300,000 surgical).
- › Pre-existing condition: any condition existing at policy start. Handling varies — see /topics/pre-existing-conditions/.
- › Affiliated / preferred provider: a specialist or hospital the insurer has a contract with — no gap payment if you use them.
- › Waiting period: time from policy start before specific benefits become available (e.g. 365 days for maternity).
- › Pharmac: NZ's drug-funding agency. Pharmac-funded drugs are usually covered; non-Pharmac are the differentiator. See /topics/pharmac-vs-non-pharmac/.
- › ACC: NZ's no-fault accident insurance scheme. Covers all injuries; health insurance excludes ACC-covered events. See /topics/acc-interaction/.
- › Gap payment: the difference between what the insurer pays and what the provider charges. See /topics/gap-payment-rules/.
Relevant deep dives
- Pre-existing conditionsNZ health insurers handle pre-existing conditions in two main ways: (1) disclose-and-accep…
- Pharmac vs non-Pharmac drug coverNZ's Pharmac funds a defined list of medicines. Non-Pharmac drugs (including high-cost can…
- ACC interactionIn NZ, ACC covers accidental injury and treatment-injury costs. Health insurance generally…
- Gap payment rulesWhen a provider's charges exceed what the insurer pays, the member pays the 'gap'. NZ insu…
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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