nib
What does nib Ultimate Health Max cover?
Ultimate Health Max is a health insurance plan from nib. Its policy wording (effective 1 February 2024) sets 54 listed exclusions.
What are the waiting periods on Ultimate Health Max?
No general waiting period is on file for this plan. That is not the same as no wait: check the pre-existing conditions section below and the PDF.
Only general waits stated in the wording are shown. Individual benefits can have their own, longer waits (some start only after 3 years of continuous cover), and your policy certificate can list personal exclusions, so confirm in the policy wording.
Compare across insurers: NZ health insurance waiting periods.
What excess options does Ultimate Health Max have?
No excess amounts were extracted from this wording; excess is usually chosen on application.
What are the benefit limits on Ultimate Health Max?
| Benefit | Limit |
|---|---|
| Foot care max | $250 |
| Osteopath max | $250 |
| Dental benefit | $500 |
| Acupuncture max | $250 |
| Chiropractor max | $250 |
| Surgical benefit | $600,000 |
| Gp surgery benefit | $5,000 |
| Foot care per visit | $40 |
| Hospice benefit max | $3,000 |
| Osteopath per visit | $40 |
| Osteopath xrays max | $80 |
| Eye care eyewear max | $330 |
| Foot surgery benefit | $6,000 |
| Non surgical benefit | $300,000 |
| Acupuncture per visit | $40 |
| Home care benefit max | $6,000 |
| Chiropractor per visit | $40 |
| Chiropractor xrays max | $80 |
| Eye injections benefit | $3,000 |
| Funeral support benefit | $10,000 |
| Osteopath acc per visit | $15 |
| Cardiac support services | $300 |
| Loyalty check up benefit | $100 |
| Parent accommodation max | $3,000 |
| Therapeutic care benefit | $1,000 |
| Acupuncture acc per visit | $15 |
| Home care benefit per day | $300 |
| Hospice benefit per night | $300 |
| Chiropractor acc per visit | $15 |
| Eye care consultations max | $275 |
| Overseas treatment benefit | $30,000 |
| Gp option consultation home | $80 |
| Gp option physiotherapy max | $400 |
| Gp option prescriptions max | $300 |
| High risk pregnancy benefit | $4,000 |
| Public hospital payment max | $3,000 |
| Cardiac counselling services | $400 |
| Medical misadventure benefit | $30,000 |
| Ear care audiometric tests max | $250 |
| Parent accommodation per night | $300 |
| Gp option consultation standard | $55 |
| Ear care audiology treatment max | $250 |
| Eye care consultations per visit | $55 |
| Gp option prescriptions per item | $15 |
| Travel and accommodation surgery | $3,000 |
| Cancer treatment support services | $300 |
| Gp option consultation acc top up | $25 |
| Public hospital payment per night | $300 |
| Speech occupation eye therapy max | $300 |
| Gp option gp surgery per procedure | $200 |
| Loyalty weight loss surgery benefit | $10,000 |
| Gp option consultations max per year | $12 |
| Cancer treatment counselling services | $400 |
| Gp option physiotherapy per treatment | $40 |
| Gp option nurse practitioner per visit | $30 |
| Gp option nurse practitioner max visits | $6 |
| Speech occupation eye therapy per visit | $40 |
| Loyalty breast reduction surgery benefit | $10,000 |
| Cancer treatment accessories scarf or hat | $50 |
| Gp option loyalty active wellness benefit | $150 |
| Gp option physiotherapy acc per treatment | $15 |
| Specialist option diagnostic tests benefit | $3,000 |
| Specialist option sports physician benefit | $500 |
| Follow up investigations for cancer benefit | $3,000 |
| Specialist option cardiac investigations benefit | $60,000 |
| Travel and accommodation accommodation per night | $300 |
| Cancer treatment accessories wig or mastectomy bra | $500 |
| Dental optical therapeutic option cost share percent | $80 |
What does Ultimate Health Max not cover?
- 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)
All nib exclusions side by side: nib exclusions.
How does Ultimate Health Max handle Pharmac drugs, ACC, mental health and pre-existing conditions?
Pharmac vs non-Pharmac drug cover
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.
ACC interaction
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.
Mental health cover
No specific mental health admission rules or sublimits are described in the available policy text.
Pre-existing conditions
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.
IVF and assisted reproduction
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.
Oncology and high-cost cancer drugs
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.
Gap payment rules
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.
Get a quote for Ultimate Health Max
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More on Ultimate Health Max
- Wording change history
- nib review (all plans)
- Machine-readable: facts.json · wording.md
Other nib plans: Easy Health · Ultimate Health