Pre-Existing Conditions and NZ Health Insurance
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.
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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A pre-existing condition is any health or medical condition that you or any child was aware of, or were experiencing signs or symptoms of, before the start of the policy, or a medical event that occurred before the start of the policy. All pre-existing conditions must be disclosed at application. Personal exclusions may be placed on the policy certificate for pre-existing conditions; these last for varying periods (from 1 year to life). Children added under 6 months of age may be added with no personal exclusions placed due to their medical history. A Medical report is required within the first 5 years of the Hospital & Surgical base plan or Specialist module if the child was added after 6 months of age and their complete medical history was not supplied at application. We may decline a claim or add a backdated exclusion for any non-disclosed pre-existing condition.
SmartCare
Wording effective 2026-05-16 · extraction confidence inferred ·
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A pre-existing condition is any health or medical condition that you're aware of, or were experiencing signs or symptoms of, before the start of your policy, or a medical event that occurred before the start of your policy. All pre-existing conditions for all Members must be disclosed at application. Underwriters assess the application and may place personal exclusions on the policy certificate; exclusions last for varying periods (from 1 year to life) depending on the medical condition. After the exclusion period has passed, the member can then claim for that condition. If a pre-existing condition is not disclosed and a claim arises relating to it, the claim may be declined. Undisclosed pre-existing conditions may be added as excluded conditions at any time, potentially backdated to the policy start date. A Medical report from the GP holding the patient's medical history is required when claiming within the first 5 years of the Hospital & Surgical base plan or Specialist module for a condition not previously claimed.
SmartCare+
Wording effective 2026-05-16 · extraction confidence inferred ·
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A pre-existing condition is any health or medical condition that the member is aware of, or was experiencing signs or symptoms of, before the start of the policy, or a medical event that occurred before the start of the policy. All pre-existing conditions must be disclosed at application. The underwriters assess each condition and may place personal exclusions on the policy certificate, which last for varying periods (from 1 year to life) depending on the medical condition. Claims may be declined for undisclosed pre-existing conditions that the member knew about or should have known about, and any such exclusion may be backdated to the policy start date. For example, a hernia present at policy start would result in a 5-year personal exclusion. Medical reports are required for claims within the first 5 years of the Hospital & Surgical+ base plan or Specialist+ module where the member has not previously claimed for that condition.
SmartStay
Wording effective 2026-05-16 · extraction confidence inferred ·
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All pre-existing conditions must be disclosed at application. A pre-existing condition is any health or medical condition the member was aware of, or experiencing signs or symptoms of, before the start of the policy, or a medical event that occurred before the start of the policy. Pre-existing conditions are excluded unless accepted by the underwriters. Personal exclusions are listed on the policy certificate and may last from 1 year to life depending on the medical condition. If a member does not provide their complete medical history at application, a Medical report from the GP holding the medical history is required for any new condition claimed within the first 5 years of the Hospital & Surgical base plan or Specialist module. UniMed reserves the right to exclude any declared or non-declared pre-existing condition or congenital condition at any time, with the exclusion potentially backdated to the policy start date. Example given: a pre-existing hernia attracts a 5-year personal exclusion.
StaffCare
Wording effective 2026-05-16 · extraction confidence verified ·
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Pre-existing conditions are excluded unless accepted by the insurer. With group insurance schemes, cover for pre-existing conditions may be offered in certain circumstances. If a full application is required, all pre-existing conditions must be disclosed. Personal exclusions may be placed on the policy certificate for pre-existing conditions, lasting from 1 year to life depending on the condition. After the exclusion period has passed, the member can then claim for that condition. If a pre-existing condition is not disclosed and a claim is made relating to it, the claim may be declined. The insurer reserves the right to exclude any declared or non-declared pre-existing condition or congenital condition at any time, backdated to the start of the policy if necessary.
StaffCare+
Wording effective 2026-05-16 · extraction confidence inferred ·
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Our Health Plans are set up to cover treatment of signs, symptoms and conditions that arise after your policy has started. However, with group insurance schemes we offer cover for pre-existing conditions in certain circumstances. If not offered cover for pre-existing conditions on application, all pre-existing conditions must be disclosed for all Members. A pre-existing condition is any health or medical condition that you're aware of, or were experiencing signs or symptoms of, before the start of your policy, or a medical event that occurred before the start of your policy. Underwriters assess all previous and current signs, symptoms and conditions; any excluded conditions are listed on the policy certificate. Personal exclusions last for different lengths of time (from 1 year to life), depending on the medical condition. After the time period listed with the exclusion has passed, you can then claim for that condition. We may decline a claim if treatment is for a pre-existing condition not included on the application form that you knew about or should have known about. We reserve the right to exclude any declared or non-declared pre-existing condition or congenital condition at any time, which may be backdated to the start of the policy.
AIA
AIA Private Health
Wording effective 2026-05-16 · extraction confidence verified ·
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Any pre-existing condition is excluded unless the symptom or condition was disclosed to AIA at the time of your application and accepted as covered by AIA in writing. If a life assured fails to disclose material information to AIA prior to inception, variation or reinstatement of the policy, or has made a substantially incorrect statement on the faith of which the policy was issued, AIA may avoid the policy from inception, alter the terms of cover, or remove the life assured from cover.
nib
Easy Health
Wording effective 2024-09-20 · extraction confidence inferred ·
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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).
Ultimate Health
Wording effective 2025-11-24 · extraction confidence inferred ·
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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.
Ultimate Health Max
Wording effective 2024-02-01 · extraction confidence verified ·
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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.
Southern Cross
KiwiCare
Wording effective 2026-04-01 · extraction confidence verified ·
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We don't cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless we've clearly stated otherwise on your membership certificate. This exclusion doesn't apply to cover provided under the 'Day-to-day treatment' benefit if you have the RegularCare plan. Pre-existing conditions that the policyholder has made us aware of are listed on the membership certificate.
RegularCare
Wording effective 2026-04-01 · extraction confidence verified ·
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The policy does not cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless clearly stated otherwise on the membership certificate. This exclusion does not apply to cover provided under the 'Day-to-day treatment' benefit for RegularCare plan holders. The policyholder must disclose any health conditions, signs, symptoms on application. Pre-existing conditions may be noted on the membership certificate.
UltraCare
Wording effective 2026-04-01 · extraction confidence inferred ·
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Pre-existing conditions are excluded unless clearly stated otherwise on the membership certificate. This exclusion does not apply after 3 years of continuous cover on this plan, and does not apply to cover under the 'Day-to-day treatment' benefit or the 'Vision and Dental' benefit (UltraCare 400 plan). Pre-existing conditions disclosed by the policyholder are listed on the membership certificate. If information on the membership certificate contradicts this policy document, the membership certificate takes precedence.
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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Pre-existing conditions are excluded unless clearly stated otherwise on the membership certificate. This exclusion does not apply to cover provided under the optional modules. The prophylactic treatment allowance is not available if the person was confirmed as having a high risk of developing the disease the prophylactic treatment is designed to prevent before their original date of joining, unless the membership certificate specifically states otherwise.
Wellbeing Two
Wording effective 2026-04-01 · extraction confidence inferred ·
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We don't cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless we've clearly stated otherwise on your membership certificate. This exclusion doesn't apply to cover provided under the optional modules. Pre-existing conditions that the policyholder has made us aware of are listed on the membership certificate.
UniMed
Health Positive
Wording effective 2025-08-01 · extraction confidence inferred ·
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Cover for pre-existing conditions is included so we do not require you to provide details of your medical history. If you choose to upgrade to a UniMed surgical plan, you will need to complete a full health declaration relating to your medical conditions at the time of upgrade.
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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Not on file for this product.
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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Pre-existing conditions are not covered unless accepted by us. A pre-existing condition means any health or medical condition you are aware of, or any signs or symptoms that you are currently experiencing or have experienced in the past, that occurred before the start of your policy, or a medical event that occurred before the start of your policy. Applicants must disclose all pre-existing conditions on application. If untrue or misleading information is provided or pre-existing conditions are not disclosed, we may decline related claims and/or apply additional personal exclusions (which may be backdated to policy start). Any personal exclusions are listed on the Membership Certificate. Personal exclusions do not apply to the Medical Repatriation or Return of Remains benefits.
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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Not on file for this product.
Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/UniCare_Advantage_Plan.pdf
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