Every section below is the verbatim text from each nib product's current policy wording PDF. Where a product doesn't address a topic, we show "Not on file" rather than guess.

Pharmac vs non-Pharmac drug cover

NZ's Pharmac funds a defined list of medicines. A medicine that is not on the Schedule, or is funded only for other conditions (Keytruda is funded for some cancers and not others), is not publicly funded for you. Health insurance can fill that gap — but every insurer handles it differently. This page summarises each NZ insurer's non-Pharmac rules verbatim from their policy wordings.

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: https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf · effective 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: https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf · effective 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: https://assets.ctfassets.net/ja9v5o5o08yv/7Acf9tvW7QiaF1lSLqnV0p/8282b54901949d83eeda17b5398ea67c/Ultimate_Health_Max_Policy_Document__effective_for_new_policies_or_policies_renewing_from_1_February_2024_or_later_.pdf · effective 2024-02-01

Compare this topic across every NZ insurer → /topics/pharmac-vs-non-pharmac/

ACC interaction

In NZ, ACC covers accidental injury and treatment-injury costs. Health insurance generally excludes ACC-covered events but most policies offer an ACC Top-Up benefit for any shortfall. This page summarises each insurer's ACC interaction rules verbatim.

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: https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf · effective 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: https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf · effective 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.

Compare this topic across every NZ insurer → /topics/acc-interaction/

Mental health cover

Mental health cover varies dramatically across NZ health insurers — from entirely excluded (entry-level plans) to specific psychiatric hospitalisation sublimits. This page lists each insurer's mental-health rules with the relevant NZD sublimits and admission terms.

Easy Health

Mental health annual 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: https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf · effective 2024-09-20

Ultimate Health

Mental health annual 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: https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf · effective 2025-11-24

Ultimate Health Max

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

Compare this topic across every NZ insurer → /topics/mental-health-cover/

Pre-existing conditions

NZ health insurers handle pre-existing conditions in two main ways: (1) disclose-and-accept (Southern Cross — exclude unless noted on certificate), or (2) stand-down period (nib — 3 years then covered, with permanent exclusions for certain conditions). This page lists each insurer's verbatim rules.

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: https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf · effective 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: https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf · effective 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.

Compare this topic across every NZ insurer → /topics/pre-existing-conditions/

IVF and assisted reproduction

IVF, infertility treatment, and assisted reproduction are excluded from virtually every NZ retail health insurance policy. This page documents each insurer's stance verbatim.

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: https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf · effective 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: https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf · effective 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.

Compare this topic across every NZ insurer → /topics/ivf-and-assisted-reproduction/

Oncology and high-cost cancer drugs

Pharmac funds many cancer medicines only for particular cancers or stages, so a high-cost drug can be funded for one patient and not another. Some NZ insurers cover these via separate cancer benefits with specific NZD caps. This page summarises each insurer's oncology / non-Pharmac chemotherapy cover.

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: https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf · effective 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: https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf · effective 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.

Compare this topic across every NZ insurer → /topics/oncology-high-cost-drugs/

Gap payment rules

When a provider's charges exceed what the insurer pays, the member pays the 'gap'. NZ insurers use different models — affiliated/preferred provider networks, percentage co-pays, 'reasonable charges' caps. This page lists each insurer's gap rules verbatim.

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: https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf · effective 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: https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf · effective 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.

Compare this topic across every NZ insurer → /topics/gap-payment-rules/

Waiting periods, excess and exclusions

Waiting periods (days)

Product	Surgical	Mental health	Maternity	Pre-existing
Easy Health	—	—	—	1095 days
Ultimate Health	—	—	—	—
Ultimate Health Max	—	—	—	—

Excess options

Excess is selected per-member on application — see source PDF.

Exclusions

Easy Health — 57 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)
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 reductions
Gynaecomastia
Mastopexy
assisted reproduction
childbirth including caesarean sections
hormone therapy
infertility
normal pregnancy, including termination of
contraception
erectile dysfunction
sterilisation or reversal of sterilisation
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)
gene therapy
genetic testing
genetic conditions, in the absence of signs or symptoms that a condition exists at your join date
concerns of familial risk or familial predisposition, in the absence of signs or symptoms that a condition exists
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
myopia, hypermetropia, presbyopia, radial keratotomy, and photo-refractive keratectomy
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 (for example: desensitisation or patch testing)
medicines that aren't funded by PHARMAC under the latest PHARMAC Pharmaceutical Schedule
conditions not registered with the Ministry of Health as a disease
pre-existing conditions (unless the condition was declared at application and was accepted by us)
any form of risk management (for example: screening, preventative, or prophylactic health services)
health surveillance testing
sleep problems or disorders (for example: snoring, insomnia, or sleep apnoea)
alternative or complementary medicine or therapy (for example: homoeopathy and natural therapy)
experimental, unproven, or unconventional treatments or procedures
services provided by someone who is not recognised by the Medical Council of New Zealand
additional surgery or treatment that isn't covered under your policy
expenses recoverable from a third party (for example: another insurer, company, or person)
health services after the applicable benefit limit has been reached
health services not covered under your policy
anything that isn't medically necessary (for example: alcohol, toiletries, car parking, visitor meals, or administration costs)
GP and out-of-hospital charges (including prescriptions)
services or goods that were received or purchased outside of New Zealand (for example: goods bought online from another country)
substance misuse (for example: misuse of alcohol or drugs)
dementia

Ultimate Health — 45 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

Ultimate Health Max — 54 exclusions

laser therapy, cryotherapy, pulse light therapy or photodynamic therapy (Skin Lesion Surgery Benefit)
consultations that don't relate to the skin lesion being removed
any surgery that isn't performed by a specialist (Surgical Benefit)
tooth extractions, except for unerupted or impacted teeth
any other dental treatments, including periodontic and endodontic treatment, orthodontic treatment and implants, and orthognathic surgery or exposure of teeth
cryotherapy, pulse light therapy, or photodynamic therapy as part of your Mohs surgery
any treatment where admission isn't supported by medical evidence (Non-Surgical Benefit)
any treatment that isn't managed by a specialist (Non-Surgical Benefit)
any treatment where the main purpose, or only purpose, is to receive an injection (for example, a pain management injection)
suites in a private hospital (Cancer Treatment Benefit)
medicines that are administered or charged for in a public hospital or at home (Non-PHARMAC Funded Medicines in Hospital Benefit)
vehicle hire (Travel and Accommodation Benefit)
travel insurance (Travel and Accommodation Benefit)
costs incurred when travelling outside New Zealand (Travel and Accommodation Benefit)
surgery or treatment that isn't available in New Zealand (Delayed Treatment Benefit)
surgery or treatment that isn't performed in an overseas private hospital (Delayed Treatment Benefit)
any surgery or treatment that can be claimed under the Overseas Treatment Benefit (Delayed Treatment Benefit)
surgery or treatment that relates to an injury which would be covered under ACC if it had happened in New Zealand (Cover in Australia Benefit)
any ambulance costs (Cover in Australia Benefit)
desensitisation, vaccinations, immunology, or allergies (Overseas Treatment Benefit)
any costs already paid under the Cover in Australia Benefit (Overseas Treatment Benefit)
any complications or ongoing treatment related to the initial treatment (Medical Tourism Benefit)
injuries that occurred before your join date (ACC Top-Up Benefit)
any stays in the private wing of a public hospital (Public Hospital Payment)
housekeeping or childcare costs (Home Care Benefit)
services provided by family members, friends, associates or anyone who doesn't meet our criteria (Cancer Treatment Counselling and Support Services Benefit)
services provided by family members, friends, associates or anyone who doesn't meet our criteria (Cardiac Counselling and Support Services Benefit)
ambulance memberships (Ambulance Transfer Benefit)
caesarean sections (High-Risk Pregnancy Benefit)
treatment of ectopic pregnancies (High-Risk Pregnancy Benefit)
any related conditions arising after the end of your pregnancy (High-Risk Pregnancy Benefit)
pregnancies conceived before your join date (High-Risk Pregnancy Benefit)
treatment in a public hospital (High-Risk Pregnancy Benefit)
IVF as a risk factor (High-Risk Pregnancy Benefit)
any diagnostic investigations, other than x-rays (Foot Surgery Benefit)
removal of corns or calluses (Foot Surgery Benefit)
any surgery other than sleeve gastrectomy, gastric banding or bypass surgery (Loyalty – Weight Loss Surgery Benefit)
any complications or follow-up treatment relating to weight loss surgery (Loyalty – Weight Loss Surgery Benefit)
tumescent liposuction or any follow-up treatment relating to breast reduction surgery (Loyalty – Breast Reduction Surgery Benefit)
procedures to reverse sterilisation (Loyalty – Sterilisation Benefit)
the death doesn't occur within 14 days of the medical misadventure (Medical Misadventure Benefit)
the cause of death has not been confirmed by a coroner's inquest (Medical Misadventure Benefit)
the medical misadventure is not the main cause of death (Medical Misadventure Benefit)
the medical misadventure happens during treatment or surgery that isn't covered by this policy (Medical Misadventure Benefit)
the death occurs as a result of treatment or surgery covered under the Medical Tourism Benefit (Medical Misadventure Benefit)
treatments covered under the school dental service or government dental scheme (Dental Benefit)
gold or other exotic materials (Dental Benefit)
orthodontic treatment, until you are eligible for the Loyalty – Orthodontic Benefit (Dental Benefit)
eyewear for fashion reasons, or tinting and transition lenses (Eye Care Benefit)
after-hours fees (Prescriptions Benefit)
administration costs (Prescriptions Benefit)
medicines that aren't prescribed by a GP, specialist, or nurse practitioner (Prescriptions Benefit)
consultations or biopsies relating to surgery (GP Surgery Benefit)
congenital conditions (Specialist Option, GP Option, Dental Optical and Therapeutic Option – dependent child pre-existing cover)

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GET /api/insurer/nib/facts.json — full insurer profile + product list (JSON)
GET /api/insurer/nib/summary.md — markdown summary (LLM-friendly)
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Source documents

Easy Health · wording effective 2024-09-20 · https://assets.ctfassets.net/px2565zobjcl/6cvBkC1suOUs7v5HKNIZX5/a5d1a25eb5608458dbedb21fe97ac431/Easy-Health-Policy-Document-Final-20.9.24.pdf
Ultimate Health · wording effective 2025-11-24 · https://assets.ctfassets.net/ja9v5o5o08yv/2I5CHtqWsDwQ2YtNOeSmFP/e2f58e9bf22d97e6cb7400f7181d6583/ultimate-health-policy-from-24-Nov-2025.pdf
Ultimate Health Max · wording effective 2024-02-01 · https://assets.ctfassets.net/ja9v5o5o08yv/7Acf9tvW7QiaF1lSLqnV0p/8282b54901949d83eeda17b5398ea67c/Ultimate_Health_Max_Policy_Document__effective_for_new_policies_or_policies_renewing_from_1_February_2024_or_later_.pdf

The authoritative source for any specific cover question is the insurer's published PDF. Our facts are a structured derivative for comparison.

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About this data. All facts on this page are extracted from each insurer's published policy wording PDF, with the source PDF, effective date, our extraction date, and SHA-256 hash recorded against every claim. If a policy has been updated since our extraction, the verbatim text and structured facts may be out of date — the authoritative answer is always the source PDF linked, not our derived facts.

Audit trail (3 source documents)

nib Easy Health · effective 2024-09-20 · extracted 2026-05-16 · source PDF
nib Ultimate Health · effective 2025-11-24 · extracted 2026-05-16 · source PDF
nib Ultimate Health Max · effective 2024-02-01 · extracted 2026-05-16 · source PDF

Personalised advice on which product fits your situation is regulated under the Financial Markets Conduct Act 2013 — for that, contact our licensed Financial Advice Provider: Evolve Group Limited (FSP711891) via /quotes/. Page rendered 2026-11-03.