Oncology and High-Cost Cancer Drugs in NZ Health Insurance
High-cost cancer drugs (Keytruda, Opdivo, etc.) are often non-Pharmac and not covered under public health. Some NZ insurers cover these via separate cancer benefits with specific NZD caps. This page summarises each insurer's oncology / non-Pharmac chemotherapy cover.
Source: each insurer's current policy wording PDF (linked inline). Last refreshed 2026-05-16.
Accuro
KidSmart
Wording effective 2026-05-16 · extraction confidence inferred ·
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Chemotherapy drugs administered orally at home, prescribed by a registered medical specialist and used during an approved cycle of chemotherapy treatment, are covered under the private hospital medical admission benefit (up to $300,000 per child per policy year). Non-Pharmac subsidised drugs (including cancer drugs registered by Medsafe but not Pharmac-funded) are covered under the non-Pharmac subsidised drugs benefit, with costs included within the maximum limit of the applicable surgical or non-surgical benefit. Up to $2,000 per child per policy year is provided for personal accessories needed during or within 6 months after cancer treatment (e.g. wig, hat, scarf).
SmartCare
Wording effective 2026-05-16 · extraction confidence inferred ·
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Non-surgical cancer treatment (including chemotherapy and radiation) is covered under the private hospital medical admission benefit, limited to $65,000 per person per policy year (included within the $200,000 benefit limit). Chemotherapy drugs administered orally at home, prescribed by a registered medical specialist and used during an approved cycle of chemotherapy treatment under the policy, are also covered. $2,000 per person per policy year is available for personal accessories needed during or within 6 months after cancer procedure or treatment (e.g. wig, hat, scarf, mastectomy bra). Oncology consultations and treatment following surgery are covered under the private hospital medical admission benefit. Prescription drugs must be Pharmac-approved and listed in sections A–I of the Pharmac Schedule; non-Pharmac drugs are not covered under the prescription drug benefit.
SmartCare+
Wording effective 2026-05-16 · extraction confidence inferred ·
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Non-Pharmac subsidised drugs benefit under the Hospital and Surgical+ base plan covers the costs of Reasonable charges associated with accessing the most effective treatment available, including drugs not subsidised by Pharmac/government, provided they are registered by Medsafe for use in New Zealand, prescribed by a registered medical specialist as appropriate medical treatment, not excluded elsewhere in the Health Plan, and prescribed within Medsafe guidelines. If the drug qualifies for a government or other subsidy, only the remaining cost is reimbursed. All costs under the non-Pharmac drugs benefit are included in the maximum limit of the relevant surgical or non-surgical benefit (up to $500,000 for general surgery or $300,000 for private hospital medical admission). Chemotherapy drugs administered orally at home, prescribed by a registered medical specialist and used during an approved cycle of chemotherapy, are also covered under the private hospital medical admission benefit ($300,000 per person per policy year). A personal accessories benefit of $2,000 per person per policy year is available for items such as wigs, hats, scarves, or mastectomy bras needed during or within 6 months after a cancer procedure or medical treatment.
SmartStay
Wording effective 2026-05-16 · extraction confidence inferred ·
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Not on file for this product.
StaffCare
Wording effective 2026-05-16 · extraction confidence verified ·
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Non-surgical cancer treatment is covered up to $60,000 per person per policy year for admission to a private hospital or facility. This includes chemotherapy drugs administered orally at home prescribed by a registered medical specialist during an approved cycle of chemotherapy treatment under the policy, as well as other prescription drugs used during non-surgical cancer treatment in hospital. No specific high-cost cancer drug benefit (such as a named drug like Keytruda) or separate oncology drug sub-limit beyond the $60,000 non-surgical cancer treatment benefit is mentioned in the policy wording.
StaffCare+
Wording effective 2026-05-16 · extraction confidence inferred ·
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The non-Pharmac cancer drugs benefit covers the costs of Reasonable charges for Medsafe-registered cancer drugs up to $40,000 for each person in a policy year, regardless of whether the drug qualifies for Pharmac funding or another government subsidy. The drug must be used in the treatment of cancer, prescribed by a registered medical specialist as the appropriate medical treatment, not excluded elsewhere in the Health Plan, and prescribed within Medsafe guidelines. If the drug qualifies for a government or other subsidy, only the remaining cost is reimbursed. All costs under this benefit are included within the maximum limit of the General surgery benefit or the Non-surgical cancer treatment limit ($65,000 per person per policy year, inclusive of non-Pharmac cancer drugs) under the Private hospital medical admission benefit. An excess applies to this benefit.
AIA
AIA Private Health
Wording effective 2026-05-16 · extraction confidence verified ·
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Under the Cancer Care benefit, the policy covers 'the cost of Pharmac and non-Pharmac subsidised MedSafe indicated cancer chemotherapy and immunotherapy drugs, subject to AIA criteria,' including targeted therapy, oral, intravenous infusion, instilled, and intraoperative chemotherapy provided by or under the direction of a specialist, whether administered in an approved facility or at home. Prior approval must be obtained before treatment takes place. The overall Cancer Care benefit maximum is $500,000 per life assured per policy year.
nib
Easy Health
Wording effective 2024-09-20 · extraction confidence inferred ·
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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.
Ultimate Health
Wording effective 2025-11-24 · extraction confidence inferred ·
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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.
Ultimate Health Max
Wording effective 2024-02-01 · extraction confidence verified ·
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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.
Southern Cross
KiwiCare
Wording effective 2026-04-01 · extraction confidence verified ·
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Under the base Chemotherapy for cancer benefit, up to $8,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer (within the overall $48,000 annual limit). Under Cancer Cover Plus Chemotherapy 100 and Chemotherapy 300 upgrades, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 or $300,000 each claims year respectively. In all cases, 80% of actual charges is covered.
RegularCare
Wording effective 2026-04-01 · extraction confidence verified ·
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Under the 'Chemotherapy for cancer (base)' benefit, up to $8,000 each claims year is included within the overall $48,000 annual limit for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer. Under the Cancer Cover Plus Chemotherapy 100 upgrade ($100,000 per claims year) and Chemotherapy 300 upgrade ($300,000 per claims year), non-Pharmac-approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, subject to the overall annual cap. No specific Keytruda example is mentioned in the policy text.
UltraCare
Wording effective 2026-04-01 · extraction confidence inferred ·
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Under the Chemotherapy for cancer (base) benefit, chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer are covered up to $10,000 each claims year (included within the overall $60,000 annual chemotherapy limit). Under Cancer Cover Plus upgrade options, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 each claims year (Chemotherapy 100) or $300,000 each claims year (Chemotherapy 300). Cancer Cover Plus excludes the specific cancer type for which a covered person has a defined family history of cancer (two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55, where the covered person was aware or should reasonably have been aware before applying); this exclusion does not apply to the base chemotherapy benefit.
Wellbeing Modules
Wording effective 2026-04-01 · extraction confidence low ·
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Not on file for this product.
Wellbeing One
Wording effective 2026-04-01 · extraction confidence inferred ·
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Under the Chemotherapy for cancer (base) benefit, up to $10,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed, within the overall $60,000 annual limit. Under the Cancer Cover Plus upgrades (Chemotherapy 100: $100,000 per claims year; Chemotherapy 300: $300,000 per claims year), chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated are covered without a separate sub-limit up to the respective annual cap. The Cancer Cover Plus upgrade excludes cover for the specific cancer where a family history of cancer exclusion applies (two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55, where the insured was or should have been aware of the diagnosis before joining).
Wellbeing Two
Wording effective 2026-04-01 · extraction confidence inferred ·
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Under the Chemotherapy for cancer (base) benefit, chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed are covered up to $10,000 each claims year, within the overall $60,000 annual limit. Under Cancer Cover Plus Chemotherapy 100 upgrade, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered within the $100,000 annual limit with no separate sub-limit. Under Cancer Cover Plus Chemotherapy 300 upgrade, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered within the $300,000 annual limit with no separate sub-limit.
UniMed
Health Positive
Wording effective 2025-08-01 · extraction confidence inferred ·
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Not on file for this product.
Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/Health_Positive_Plan.pdf
Hospital Select
Wording effective 2025-08-01 · extraction confidence low ·
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Under the Chemotherapy benefit, Non-Pharmac chemotherapy drugs that are Medsafe approved for the treatment of cancer are included in cover up to a maximum of $10,000 per annum, within an overall Chemotherapy benefit limit of $65,000 per policy year. The In-Patient Non-Pharmac Subsidised Pharmaceuticals benefit also covers Medsafe-approved pharmaceuticals not fully or partly subsidised by Pharmac, up to $2,000 per policy year.
Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/Hospital_Select_Plus_Modules_Plan.pdf
ParentStay
Wording effective 2025-10-01 · extraction confidence inferred ·
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Not on file for this product.
Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/ParentStay-Health-Plan-2025.pdf
UniCare Advantage
Wording effective 2025-08-01 · extraction confidence low ·
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Non-Pharmac chemotherapy drugs that are Medsafe approved for the treatment of cancer are covered up to $8,500 per annum, included within the overall Chemotherapy benefit of $55,000 per policy year. Genetic/genomic testing is also included, payable following a cancer diagnosis and referral by a Registered Oncologist.
Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/UniCare_Advantage_Plan.pdf
Machine-readable version
Same content as plain text: /api/topic/oncology-high-cost-drugs/summary.md
Per-product JSON facts: see llms.txt for the full endpoint list.