Specialist waiting times — getting seen privately
Specialist consultation cover, second-opinion benefits, and how quickly private cover bypasses public waiting lists.
You've been referred by your GP and the public-system specialist appointment is months away. Private cover for specialist consults gets you seen in days/weeks instead. The benefit-line shapes (per-visit cap, annual cap, % reimbursement, pre-approval required) determine how easily you can actually use it.
Top policies for this scenario
Ranked by aggregate semantic match across 5 scenario-specific queries. Score reflects clause-level fit, not premium. We don't know what you'd pay — get a quote for the shortlist.
- score 1.24
#1 · Accuro
SmartCare
Show matched clauses (4)
Query: "specialist consultation cover per visit and annual cap" · similarity 64% · weight 1
SmartCare at a glance > Start with the base plan and add additional modules > Additional modules/Health Plan > Specialist module
Cover for specialist consultations and diagnostic tests.
Source PDF →Query: "specialist diagnostic imaging cover" · similarity 72% · weight 0.7
SmartCare at a glance > Start with the base plan and add additional modules > Additional modules/Health Plan > Specialist module
Cover for specialist consultations and diagnostic tests.
Source PDF →Query: "second medical opinion cover" · similarity 62% · weight 0.7
Additional modules > Specialist module > Specialist consultations > Second opinion
This benefit covers the costs of Reasonable charges for you to consult a registered medical specialist for a second opinion on a diagnosis or a treatment plan that is covered under this policy. You must have received your first diagnosis from a registered medical specialist.
Source PDF →Query: "pre-approval prior authorisation required" · similarity 67% · weight 0.5 (negative — counts against)
How to apply for prior approval
Prior approval is when we confirm cover under your policy before your procedure or medical treatment (such as a surgery) happens. We'll also tell you of any conditions or excess that may apply. We need 2 working days to process prior approvals. Prior approval is required: - for any procedure or medical treatment that is likely to cost $1,000 or more - if your procedure or medical treatment requi…
Source PDF → - score 1.22
#2 · Accuro
KidSmart
Show matched clauses (4)
Query: "specialist consultation cover per visit and annual cap" · similarity 64% · weight 1
KidSmart at a glance > Start with the base plan and add additional modules > Specialist module
Cover for specialist consultations and diagnostic tests.
Source PDF →Query: "specialist diagnostic imaging cover" · similarity 72% · weight 0.7
KidSmart at a glance > Start with the base plan and add additional modules > Specialist module
Cover for specialist consultations and diagnostic tests.
Source PDF →Query: "second medical opinion cover" · similarity 58% · weight 0.7
Specialist module > Specialist consultations and treatment > Second opinion
This benefit covers the costs of Reasonable charges for the child to consult a registered medical specialist for a second opinion on a diagnosis or a treatment plan that is covered under this policy. The child must have received their first diagnosis from a registered medical specialist.
Source PDF →Query: "pre-approval prior authorisation required" · similarity 66% · weight 0.5 (negative — counts against)
How to apply for prior approval
Prior approval is when we confirm cover under the policy before the child's procedure or medical treatment (such as a surgery) happens. We'll also tell you of any conditions that may apply. We need 2 working days to process prior approvals. Prior approval is required: - for any procedure or medical treatment that is likely to cost $1,000 or more - if the procedure or medical treatment requires h…
Source PDF → - score 1.20
#3 · Southern Cross
RegularCare
Show matched clauses (4)
Query: "specialist consultation cover per visit and annual cap" · similarity 67% · weight 1
Section B: What the KiwiCare and the RegularCare plans cover > Consultations > Specialist consultations
**$4,000 each claims year** This benefit provides cover for consultations performed by a specialist who is an Affiliated Provider contracted for consultations. Consultations with a health services provider who is working under the supervision of a specialist are also covered if this type of consultation is: - included in the Affiliated Provider's contract with us, and - approved by us. This be…
Source PDF →Query: "specialist diagnostic imaging cover" · similarity 62% · weight 0.7
Section B: What the KiwiCare and the RegularCare plans cover > Imaging and tests
The following diagnostic imaging and tests are covered.
Source PDF →Query: "second medical opinion cover" · similarity 59% · weight 0.7
Section D: How to make a claim > Other things you should know about making a claim > We may seek the advice of a health services provider chosen by us, to advise us about the medical facts or examine you in relation to your claim
In exceptional circumstances, we may need to seek the opinion of a health services provider of our choosing, at our expense, to review and assess the medical facts or examine you in relation to a claim. We'll only do this when there's uncertainty on the level of cover under this policy or the nature or extent of your condition. You must co-operate with the health services provider we choose, or w…
Source PDF →Query: "pre-approval prior authorisation required" · similarity 63% · weight 0.5 (negative — counts against)
Section D: How to make a claim > When to apply for prior approval
Through prior approval we confirm whether a healthcare service is eligible for cover and the conditions that apply. We recommend that you apply for prior approval at least 5 working days before the healthcare service is being provided. You'll need to give us the estimated charges from your health services provider so we can determine the cover you're entitled to (including any excess you need to …
Source PDF → - score 1.20
#4 · Southern Cross
KiwiCare
Show matched clauses (4)
Query: "specialist consultation cover per visit and annual cap" · similarity 67% · weight 1
Section B: What the KiwiCare and the RegularCare plans cover > Consultations > Specialist consultations
**$4,000 each claims year** This benefit provides cover for consultations performed by a specialist who is an Affiliated Provider contracted for consultations. Consultations with a health services provider who is working under the supervision of a specialist are also covered if this type of consultation is: - included in the Affiliated Provider's contract with us, and - approved by us. This be…
Source PDF →Query: "specialist diagnostic imaging cover" · similarity 62% · weight 0.7
Section B: What the KiwiCare and the RegularCare plans cover > Imaging and tests
The following diagnostic imaging and tests are covered.
Source PDF →Query: "second medical opinion cover" · similarity 59% · weight 0.7
Section D: How to make a claim > Other things you should know about making a claim > We may seek the advice of a health services provider chosen by us, to advise us about the medical facts or examine you in relation to your claim
In exceptional circumstances, we may need to seek the opinion of a health services provider of our choosing, at our expense, to review and assess the medical facts or examine you in relation to a claim. We'll only do this when there's uncertainty on the level of cover under this policy or the nature or extent of your condition. You must co-operate with the health services provider we choose, or w…
Source PDF →Query: "pre-approval prior authorisation required" · similarity 63% · weight 0.5 (negative — counts against)
Section D: How to make a claim > When to apply for prior approval
Through prior approval we confirm whether a healthcare service is eligible for cover and the conditions that apply. We recommend that you apply for prior approval at least 5 working days before the healthcare service is being provided. You'll need to give us the estimated charges from your health services provider so we can determine the cover you're entitled to (including any excess you need to …
Source PDF → - score 1.20
#5 · Southern Cross
UltraCare
Show matched clauses (4)
Query: "specialist consultation cover per visit and annual cap" · similarity 67% · weight 1
B – What the UltraCare plans cover > Consultations > Specialist consultations
**$10,000 each claims year** This benefit provides cover for consultations performed by a specialist, including consultations for getting a second opinion on your diagnosis or treatment plan by a specialist. This benefit also provides cover for consultations with a health services provider who is working under the supervision of a specialist who is an Affiliated Provider if this type of consulta…
Source PDF →Query: "specialist diagnostic imaging cover" · similarity 62% · weight 0.7
B – What the UltraCare plans cover > Imaging and tests
The following diagnostic imaging and tests are covered.
Source PDF →Query: "second medical opinion cover" · similarity 59% · weight 0.7
D – How to make a claim > Other things you should know about making a claim > We may seek the advice of a health services provider chosen by us, to advise us about the medical facts or examine you in relation to your claim
In exceptional circumstances, we may need to seek the opinion of a health services provider of our choosing, at our expense, to review and assess the medical facts or examine you in relation to a claim. We'll only do this when there's uncertainty on the level of cover under this policy or the nature or extent of your condition. You must co-operate with the health services provider we choose, or w…
Source PDF →Query: "pre-approval prior authorisation required" · similarity 63% · weight 0.5 (negative — counts against)
D – How to make a claim > When to apply for prior approval
Through prior approval we confirm whether a healthcare service is eligible for cover and the conditions that apply. We recommend that you apply for prior approval at least 5 working days before the healthcare service is being provided. You'll need to give us the estimated charges from your health services provider so we can determine the cover you're entitled to and whether the estimated charges …
Source PDF →
What to watch out for
- pre-approval: Some policies require written pre-approval BEFORE the consultation; failure to obtain = no cover. Check the workflow.
- cap: Per-visit specialist caps of $150-200 are well below actual NZ specialist fees ($300-600). The gap is yours to pay.
Ready to shortlist a policy for specialist waiting times — getting seen privately?
The ranking above is mechanical clause-matching. To get a personalised shortlist with real premium quotes, take the 60-second quick-pick or talk to our FMA-licensed adviser (FSP711891).
No cost to you · FMA-licensed adviser · We earn commission from insurers if you proceed
How this ranking works
This scenario translates to 5 semantic queries (weighted). Each query runs against every NZ health insurance policy clause we've ingested (3,000+ clauses across 5 insurers). The best clause-per-product per query contributes its similarity × weight to the product's aggregate score.
Try the underlying semantic clause search to run your own queries.
This is mechanical retrieval + ranking — not personalised financial advice. The actual policy you should buy depends on factors only an FSPR-registered adviser can assess (your medical history, budget, family composition, risk tolerance). Use this to shortlist, then talk to an adviser.