nib vs Partners Life — Health Insurance

Easy Health

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.

Source PDF · 2024-09-20

Ultimate Health

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.

Source PDF · 2025-11-24

Ultimate Health Max

Medicines funded by PHARMAC are covered as in-hospital pharmaceutical prescriptions under the Surgical and Non-Surgical Benefits. Non-PHARMAC funded medicines are covered under the Non-PHARMAC Funded Medicines in Hospital Benefit (up to the remaining Surgical or Non-Surgical Benefit limit) and the Non-PHARMAC Funded Medicines at Home Benefit (for up to six months after private hospital admission, up to the remaining Surgical or Non-Surgical Benefit limit), provided the medicine is approved by Medsafe and used within Medsafe approval. The Non-PHARMAC Plus Option provides an additional benefit limit (specified on the Acceptance or Renewal Certificate) for non-PHARMAC funded medicines after specialist referral, covering medicines approved by Medsafe and used within Medsafe approval, that are not funded by PHARMAC at the time of treatment. No specific Keytruda example is mentioned in the available text.

Source PDF · 2024-02-01

Easy Health

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.

Source PDF · 2024-09-20

Ultimate Health

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.

Source PDF · 2025-11-24

Ultimate Health Max

The ACC Top-Up Benefit covers the difference between what ACC pays and the cost of surgery or medical treatment for a physical injury, up to the remaining Surgical or Non-Surgical Benefit limit. Injuries that occurred before the join date are excluded. If ACC reimburses the insured person after nib has paid, the reimbursement must be forwarded to nib. Under the Cover in Australia Benefit, surgery or treatment relating to an injury that would be covered under ACC if it had happened in New Zealand is excluded. 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 that is not covered by ACC, up to the remaining Surgical or Non-Surgical Benefit limit; if ACC declines to pay, nib may request an ACC review on the insured person's behalf.

Source PDF · 2024-02-01

Easy Health

MH sublimit: Not covered — psychiatric, psychological, behavioural, or developmental conditions (for example: depression, ADHD, and eating disorders) are a general exclusion with no sublimit provided.

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.

Source PDF · 2024-09-20

Ultimate Health

MH sublimit: 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

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.

Source PDF · 2025-11-24

Ultimate Health Max

No specific mental health admission rules or sublimits are described in the available policy text.

Source PDF · 2024-02-01

Easy Health

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).

Source PDF · 2024-09-20

Ultimate Health

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.

Source PDF · 2025-11-24

Ultimate Health Max

Pre-existing conditions may be excluded as personal exclusions listed on the Acceptance or Renewal Certificate. If a dependent child is added to the Specialist Option, GP Option, or Dental, Optical, and Therapeutic Option within four months of birth, their pre-existing conditions are covered under those Options, except for any congenital conditions.

Source PDF · 2024-02-01

Easy Health

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.

Source PDF · 2024-09-20

Ultimate Health

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.

Source PDF · 2025-11-24

Ultimate Health Max

IVF is not considered a risk factor under the High-Risk Pregnancy Benefit and is therefore not covered under that benefit. No other IVF cover is described in the available policy text.

Source PDF · 2024-02-01

Easy Health

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.

Source PDF · 2024-09-20

Ultimate Health

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.

Source PDF · 2025-11-24

Ultimate Health Max

Non-PHARMAC funded medicines required in a private hospital are covered under the Non-PHARMAC Funded Medicines in Hospital Benefit up to the remaining Surgical or Non-Surgical Benefit limit (up to $600,000 surgical / $300,000 non-surgical per policy year). Non-PHARMAC funded medicines used at home for up to six months after private hospital admission are covered under the Non-PHARMAC Funded Medicines at Home Benefit up to the remaining Surgical or Non-Surgical Benefit limit. The Non-PHARMAC Plus Option provides a separately specified benefit limit (as stated on the Acceptance or Renewal Certificate) for non-PHARMAC funded medicines after specialist referral, in hospital or at home. All such medicines must be approved by Medsafe and used within Medsafe approval.

Source PDF · 2024-02-01

Easy Health

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.

Source PDF · 2024-09-20

Ultimate Health

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.

Source PDF · 2025-11-24

Ultimate Health Max

The policy pays 100% of eligible costs up to the available benefit limit for Base Cover and most Options (Specialist Option, Non-PHARMAC Plus Option, GP Option). The Dental, Optical, and Therapeutic Option pays 80% of eligible costs up to the available benefit limit. The Medical Tourism Benefit pays a maximum of 75% of the usual, customary and reasonable charges that would have been payable in New Zealand. The Cover in Australia Benefit and Delayed Treatment Benefit pay up to the usual, customary and reasonable charges that would have been payable in New Zealand, up to the overall benefit limit. Payments are made in New Zealand Dollars to the selected New Zealand bank account of the policyowner or insured person and are not paid directly to the health service provider for overseas treatment benefits.

Source PDF · 2024-02-01